Title Page

  • Conducted on

  • Prepared by

  • Location
  • At 4 feet depth, there is a provided means of egress. (Ramps, Ladders)

  • For every 25 feet of excavation/trench there must be a ramp or ladder.

  • There are no tools, equipment, or soil within 2 feet of any excavation/trench.

  • For excavations/trenches that are 5 feet and over in depth there is a provided protective system. (Sloping, Benching, Shielding)

  • Work is to be performed no less than 10 feet away from all electrical hazards

  • Excavations over 6 feet are barricaded off at all times to prevent access.

  • Ladders are secured and extend 3 feet above the means of access.

  • Shields must be no more than 2 feet from the bottom of an excavation/trenches

  • Shields are to extend 18 inches above the point where proper sloping begins.

  • Excavation/Trenches are to be inspected by a competent person and reassessed as conditions change such as incliment weather.

  • Comments:

  • Select date

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.