Excavation & Trench Verification

• Site conducted

  Select

• Conducted on

  Date

• Case number

• Prepared by

  Sign
• Location
  Address

• Contractor

• Key contact

Inspection

• Excavation break in permit completed?

  Yes

  No

  N/A

• Excavation work plan prepared?

  Yes

  No

  N/A

• Competent person provided a design for excavations <1.5 metre in depth?

  Yes

  No

  N/A

• SWMS prepared for excavations <1.5 metres depth?

  Yes

  No

  N/A

• Have SWMS been prepared for excavations where there is a risk of falling more than 2 metres?

  Yes

  No

  N/A

• Underground services been identified prior to work starting using approved methods?

  Yes

  No

  N/A

• Where underground services are present they are marked and protected where required?

  Yes

  No

  N/A

• Where appropriate ground movement controlled and collapse prevented by shoring, sloping, benching etc.

  Yes

  No

  N/A

• If the sides of the excavation are sloped back or battered, angle of batter sufficient to prevent collapse

  Yes

  No

  N/A

• Adequate supply of shoring timber or other supporting material available

  Yes

  No

  N/A

• Shoring or trench support installed, removed or altered under the supervision of competent person

  Yes

  No

  N/A

• Safe access and egress to the excavation provided

  Yes

  No

  N/A

• Protection/guards to stop people and materials falling in

  Yes

  No

  N/A

• Appropriate barriers provided to keep vehicles away

  Yes

  No

  N/A

• Excavation located so that it will not affect the stability of adjacent structures

  Yes

  No

  N/A

• Hand digging specified where necessary

  Yes

  No

  N/A

• Materials, excavated material or plant stored at least 1.5 metres away from the edge of the excavation

  Yes

  No

  N/A

• Are deep excavations treated as confined space

  Yes

  No

  N/A

• Emergency plan has been prepared

  Yes

  No

  N/A

• Has the possibility of the excavation filling with water been considered and appropriate measures taken

  Yes

  No

  N/A

• Measures to prevent contamination of ground water

  Yes

  No

  N/A

• Are all personnel outside the trench while heavy equipment is working above

  Yes

  No

  N/A

• Presence of overhead power lines been considered

  Yes

  No

  N/A

• Weather conditions been taken into consideration

  Yes

  No

  N/A

• Daily inspections of the excavation or trench systems being performed by the Geotechnical Engineer prior to work commencing

  Yes

  No

  N/A

• Where there is infrastructure within the excavation or trench has it been secured or protected to prevent falls or damage - cabling, piping, pits etc.

  Yes

  No

  N/A

• On visual inspection is the trench/excavation failing - earth fretting, slipping, slumping or ground swelling

  Yes

  No

  N/A

Corrective Actions

• Corrective Actions taken