Agrodrain: Excavation/Trench Inspection Checklist

• Site

• Job Number

• Project Location
  Address

• date

  Date

• Foreman/Supervisor

Excavation Information

• Has Notice of Project been submitted

  Yes

  No

  N/A

• Notice of trench submitted if trench

  Yes

  No

  N/A

• Purpose of Trenching

  Drainage

  Sewer

  Water

  Gas

  Other

• Enter other purpose

• Excavation Depth

  Yes

  No

  N/A

• Excavation Width

  Yes

  No

  N/A

• Equipment being used

• Name of Operator

• Has the equipment been inspected prior to starting the task?

  Yes

  No

• Weather

  Select Rainy Stormy Cloudy Sunny Hot Dry Wet Foggy Snow

  • Rainy
  • Stormy
  • Cloudy
  • Sunny
  • Hot
  • Dry
  • Wet
  • Foggy
  • Snow

• Number of workers on site

• Have there been safety talk to workers about excavation safety?

  Yes

  No

  N/A

• Has a visual or manual test of soil been performed?

  Yes

  No

  N/A

• Based on the Visual Test conducted, the soil is:

  Cohesive

  Granular

• Manual Test performed:

  Plasticity

  Dry Strength

  Thumb Penetration

  Penetrometer

  Shearvane

• Soil Type

  Select 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)

  • 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)

• Who or what organization performed the soil test?

• Protective System

  Select Trench shield (box) Sloping Wood shoring Other

  • Trench shield (box)
  • Sloping
  • Wood shoring
  • Other

• Enter other protective system

Jobsite Inspection

• Spoils, materials, and equipment set back at least two feet from the edge of the excavation.

  Yes

  No

  N/A

• If necessary protective systems will be put in place to mitigate falling/rolling hazard from loose rock or soil during excavation.

  Yes

  No

  N/A

• Workers are required to stand away (1 meter) from equipment and vehicles being loaded or unloaded.

  Yes

  No

  N/A

• PPE (Hard hat,steel toe boot and reflective vest) are required at all times

  Yes

  No

  N/A

Utilities

• Have all utilities been located and marked?

  Yes

  No

  N/A

Entry and Exit

• Ladders used in excavations secured and in good shape

  Yes

  No

  N/A

• Is there a safe means of access & egress

  Yes

  No

  N/A

Wet Conditions

• Surface water or runoff diverted /controlled to prevent accumulation in the excavation.

  Yes

  No

  N/A

• Is the excavation/trench safe to enter?

  Yes

  No

  N/A

Recommendations

• Enter recommendations here

Completion

• Follow up

• Attendance

• Full Name and Signature of Fore Man

  Sign

• Name of worker

  Sign