Title Page

  • Client / Site

  • Conducted on

Excavation Information

  • Purpose of Trenching

  • Enter other purpose

  • Excavation Depth

  • Excavation Width

  • Take photo of the excavation area

  • Equipment being used

  • Has the equipment been inspected prior to starting the task?

  • Approximate Temperature

  • Weather

  • Has a visual and manual test been performed?

  • Based on the Visual Test conducted, the soil is:

  • Manual Test performed:

  • Soil Type

  • Protective System

  • Enter other protective system

Jobsite Inspection

  • Excavations, adjacent areas, and protective systems inspected by a competent person daily prior to the start of work.

  • Competent person has the authority to remove employees from the excavation immediately.

  • Surface encumbrances removed or supported i.e. sidewalk, curb and gutter, light poles, vaults, etc.

  • Spoils, materials, and equipment set back at least two feet from the edge of the excavation.

  • Barriers provided at all remotely located excavations, wells, pits, shafts, etc.

  • Walkways and bridges over excavations four feet or more in depth are equipped with standard guardrails and toe-boards.

  • Warning system established and utilized when mobile equipment is operating near the edge of the excavation.

  • Employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation.

  • Employees required to stand away from vehicles being loaded or unloaded.

  • Employees prohibited from standing or working underneath suspended loads.

  • Employees prohibited from working on the faces of slopes or benched excavations above other employees.

  • Employees wearing the required PPE for the task they are doing.

Utilities

  • Have all utilities been located and marked?

  • What type of marks are present?

  • Underground facilities shall be marked in accordance with the following designated color code:
    White: Pre-marking of the outer limits of the proposed excavation or marking the centerline and width of proposed lineal installations of buried facilities.
    Pink: Temporary Survey Markings.
    Red: Electric power lines, cables or conduit, and lighting cables.
    Yellow: Gas, oil, steam, petroleum, or other hazardous liquid or gaseous materials.
    Orange: Communications, cable TV, alarm or signal lines, cables or conduits.
    Blue: Water, irrigation, and slurry lines.
    Purple: Slurry and reclaimed.
    Green: Sewers, drainage facilities or other drain lines.

  • Underground installations protected, supported, or removed when excavation is open?

Entry and Exit

  • Lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth.

  • Ladders used in excavations secured and extended three feet above the edge of the trench.

  • Structural ramps used by employees designed by a competent person.

  • Structural ramps used for equipment designed by a registered professional engineer.

  • Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with no-slip surface.

  • Employees protected from cave-ins when entering or exiting the excavation.

Wet Conditions

  • Precautions taken to protect employees from the accumulation of water.

  • Surface water or runoff diverted or controlled to prevent accumulation in the excavation.

  • Inspections made after every rainstorm or other hazard increasing occurrence.

Hazardous Atmosphere

  • Atmosphere within the excavation tested where there is a reasonable possibility of an oxygen deficiency, combustible, or other harmful contaminant exposing employees to a hazard.

  • Adequate precautions taken to protect employees from exposure to an atmosphere containing less than 19.5 percent oxygen and/or to other hazardous atmosphere.

  • Ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10 percent of the lower explosive limit of the gas.

  • Testing conducted continuously to ensure that the atmosphere remains safe.

  • Emergency equipment, such as breathing apparatus, safety harness and lifeline, and/or basket stretcher readily available where hazardous atmospheres could or actually do exist.

  • Employees trained to use personal protective and other rescue equipment.

Protective Systems

  • Materials and/or equipment for protective system selected based on soil analysis, trench depth, and expected loads.

  • Materials and equipment used for protective systems inspected and in good condition (pins, keepers, etc.).

  • Materials and equipment not in good condition have been removed from service.

  • Damaged materials and equipment used for protective systems inspected by a competent person after repairs and before being placed back into service.

  • Protective systems installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment.

  • Members of protective system securely fastened to prevent failure.

  • Tabulated data on protective system available for review?

  • Backfilling progresses with removal of protective system.

  • Excavation of material to a level no greater than two feet below the bottom of the protective system and only if the system is designed to support the loads calculated for the full depth.

  • Shield system placed no more than 6-8 inches from each side of the box to prevent lateral movement.

  • Employees are prohibited from remaining in shield system during vertical movement.

Recommendations

  • Enter recommendations here

Completion

  • Full Name and Signature of Competent Person

  • Full Name and Signature of Inspector

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