EXCAVATION & TRENCH INSPECTION CHECKLIST sample

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Inspectors Name:

• Inspectors Signature:

  Sign
• Work location
  Address

• Date

  Date

• Permit No.

• Work Description

Weather

• Rain

  Yes

  No

  N/A

• Ice / Freezing / Other

  Yes

  No

  N/A

Surface Conditions

• No Surface Cracks

  Yes

  No

  N/A

• Equip / Materials away from edge

  Yes

  No

  N/A

• Spoil away from edges

  Yes

  No

  N/A

• Vibration sources

  Yes

  No

  N/A

• Barricading in place ( Humans, animals, Vegetation )

  Yes

  No

  N/A

• Lighting in place

  Yes

  No

  N/A

• Walkways and bridges

  Yes

  No

  N/A

Sloping, Benching or Shoring

• Compliance with Design

  Yes

  No

  N/A

• In place and functioning

  Yes

  No

  N/A

• Movement or deflection

  Yes

  No

  N/A

Excavation

• Adequate Access / Egress for employees and fauna

  Yes

  No

  N/A

• Stairs, Ladders and ramps

  Yes

  No

  N/A

• Dewatering / No standing water

  Yes

  No

  N/A

• Build up of gasses

  Yes

  No

  N/A

Compliance with Permits, Procedures and Job Requirements

• Excavation and trench permit

  Yes

  No

  N/A

• Recorded on Excavation Permit Register

  Yes

  No

  N/A

• Task Risk Assesment

  Yes

  No

  N/A

• Isolation, Lock out / Tag out

  Yes

  No

  N/A

• PPE

  Yes

  No

  N/A

Additional Information