Title Page
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Customer/Client Name
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Project Location Address
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DDS Division
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Conducted on
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Prepared by
Excavation Information
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Excavation project description
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Purpose of Trenching
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Enter other purpose
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Excavation Depth
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Excavation Width
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Take photo of the excavation area
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Excavation tools and machines used
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Has all heavy equipment undergone safety checks?
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Approximate Temperature
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Weather
- Rainy
- Stormy
- Cloudy
- Sunny
- Hot
- Dry
- Wet
- Foggy
- Snow
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Soil Type
- Stable rock
- Type A
- Type B
- Type C
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Protective System
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Enter other protective system
Jobsite Inspection
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Competent person has the authority to remove employees from the excavation immediately.
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Excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work.
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Surface encumbrances removed or supported.
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REFERENCE: No encrumbrances like utilities, foundations, streams, water tables, transformer vaults, walkways, bridges, roads, and geologic anomalies present
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections] -
Spoils, materials, and equipment set back at least two feet from the edge of the excavation.
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Barriers provided at all remotely located excavations, wells, pits, shafts, etc.
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Walkways and bridges over excavations four feet or more in depth are equipped with standard guardrails and toeboards.
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Warning system established and utilized when mobile equipment is operating near the edge of the excavation.
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Employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation.
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Employees required to stand away from vehicles being loaded or unloaded.
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Employees prohibited from going under suspended loads.
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Employees prohibited from working on the faces of slopes or benched excavations above other employees.
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Hard hats worn by all employees.
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Warning vests or other highly visible clothing provided and worn by all employees exposed to public vehicular traffic.
Utilities
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Utility companies contacted and/or utilities located.
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Exact location of utilities marked.
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Underground installations protected, supported, or removed when excavation is open.
Entry and Exit
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Lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth.
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Ladders used in excavations secured and extended three feet above the edge of the trench.
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Structural ramps used by employees designed by a competent person.
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Structural ramps used for equipment designed by a registered professional engineer (RPE)
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Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with no-slip surface.
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Employees protected from cave-ins when entering or exiting the excavation.
Wet Conditions
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Precautions take to protect employees from the accumulation of water.
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Water removal equipment monitored by a competent person.
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Surface water or runoff diverted or controlled to prevent accumulation in the excavation.
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Inspections made after every rainstorm or other hazard-increasing occurrence.
Hazardous Atmosphere
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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.
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Adequate precautions taken to protect employees from exposure to an atmosphere containing less than 19.5% oxygen and/or to other hazardous atmospheres
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Ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas.
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Testing conducted often to ensure that the atmosphere remains safe.
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Emergency equipment, such as breathing apparatus, safety harness and lifeline, and/or basket stretcher readily available where hazardous atmospheres could or do exist.
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Employees trained to use personal protective and other rescue equipment.
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Safety harness and lifeline used and individually attended when entering bell bottom or other deep confined excavations
Support Systems
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Materials and/or equipment for support systems selected based on soil analysis, trench depth, and expected loads.
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Materials and equipment used for protective systems inspected and in good condition.
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Materials and equipment not in good condition have been removed from service.
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Damaged materials and equipment used for protective systems inspected by a registered professional engineer (RPE) after repairs and before being placed back into service.
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Protective systems installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment.
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Members of support system securely fastened to prevent failure.
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Support systems provided in ensure stability of adjacent structures, buildings, roadways, sidewalks, walls, etc.
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Excavations below the level of the base or footing supported, approved by an RPE.
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Removal of support systems progresses from the bottom and members are released lowly as to note any indication of possible failure.
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Backfilling progresses with removal of support system.
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Excavation of material to a level no greater than two feet below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth.
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Shield system placed to prevent lateral movement.
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Employees are prohibited from remaining in shield system during vertical movement.
Recommendations
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Enter recommendations here
Completion
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Full Name and Signature of Competent Person
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Full Name and Signature of Inspector