Title Page
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Site
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Job Number
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Project Location
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date
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Foreman/Supervisor
Excavation Information
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Has Notice of Project been submitted
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Notice of trench submitted if trench
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Purpose of Trenching
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Enter other purpose
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Excavation Depth
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Excavation Width
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Equipment being used
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Name of Operator
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Has the equipment been inspected prior to starting the task?
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Weather
- Rainy
- Stormy
- Cloudy
- Sunny
- Hot
- Dry
- Wet
- Foggy
- Snow
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Number of workers on site
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Have there been safety talk to workers about excavation safety?
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Has a visual or manual test of soil been performed?
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Based on the Visual Test conducted, the soil is:
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Manual Test performed:
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Soil Type
- Stable rock
- Type A (1.5 tsf or greater)
- Type B (0.5 tsf to 1.5 tsf)
- Type C (0.5 tsf or less)
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Who or what organization performed the soil test?
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Protective System
- Trench shield (box)
- Sloping
- Wood shoring
- Other
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Enter other protective system
Jobsite Inspection
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Spoils, materials, and equipment set back at least two feet from the edge of the excavation.
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If necessary protective systems will be put in place to mitigate falling/rolling hazard from loose rock or soil during excavation.
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Workers are required to stand away (1 meter) from equipment and vehicles being loaded or unloaded.
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PPE (Hard hat,steel toe boot and reflective vest) are required at all times
Utilities
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Have all utilities been located and marked?
Entry and Exit
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Ladders used in excavations secured and in good shape
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Is there a safe means of access & egress
Wet Conditions
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Surface water or runoff diverted /controlled to prevent accumulation in the excavation.
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Is the excavation/trench safe to enter?
Recommendations
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Enter recommendations here
Completion
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Follow up
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Attendance
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Full Name and Signature of Fore Man
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Name of worker