• Inspectors Name:

  • Inspectors Signature:

  • Work location
  • Date

  • Permit No.

  • Work Description

Weather

  • Rain

  • Ice / Freezing / Other

Surface Conditions

  • No Surface Cracks

  • Equip / Materials away from edge

  • Spoil away from edges

  • Vibration sources

  • Barricading in place ( Humans, animals, Vegetation )

  • Lighting in place

  • Walkways and bridges

Sloping, Benching or Shoring

  • Compliance with Design

  • In place and functioning

  • Movement or deflection

Excavation

  • Adequate Access / Egress for employees and fauna

  • Stairs, Ladders and ramps

  • Dewatering / No standing water

  • Build up of gasses

Compliance with Permits, Procedures and Job Requirements

  • Excavation and trench permit

  • Recorded on Excavation Permit Register

  • Task Risk Assesment

  • Isolation, Lock out / Tag out

  • PPE

Additional Information

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