Berg Electric - Daily Trench Inspection record

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Utilities located prior to excavation?

  Yes

  No

  N/A

Protective system used:

• Shield

• Slope

• Shore

Measurements of Trench:

• Depth

• Length

• Width

• Purpose of Trench

• Was a visual soil test conducted?

  Yes

  No

  N/A

• Was a manual soil test conducted

  Yes

  No

  N/A

• Are there surface encumbrance?

  Yes

  No

  N/A

• Hazardous atmosphere?

  Yes

  No

  N/A

• Surcharge load?

  Yes

  No

  N/A

Water conditions:

• Wet

• Dry

• Soil type: A - B - C

• Is trench exposed to vehicular exhaust?

  Yes

  No

  N/A

• Are employees exposed to vehicular traffic?

  Yes

  No

  N/A

• Are utilities protected

  Yes

  No

  N/A

• Are ladders within 25' of all workers?

  Yes

  No

  N/A

• Do ladders extend 3' above the surface?

  Yes

  No

  N/A

• Are spoils kept 2' from the edge of trench?

  Yes

  No

  N/A

• Are employees excavation trained?

  Yes

  No

  N/A

• Comments:

• Competent person name

  Sign

• Signature

  Sign