Excavation Safety Audit Form - duplicate

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PPE

• Hard Hats

  Safe

  At Risk

  N/A

• Glasses/Goggles/Faceshield

  Safe

  At Risk

  N/A

• Harness and Lanyard Use

  Safe

  At Risk

  N/A

• Hearing Protection Needed

  Safe

  At Risk

  N/A

• Proper Clothing

  Safe

  At Risk

  N/A

• Tools Inspected

  Safe

  At Risk

  N/A

• Guards in Place

  Safe

  At Risk

  N/A

Equipment

• Inspected Daily

  Safe

  At Risk

  N/A

• Back Up Alarm working

  Safe

  At Risk

  N/A

• Free from excessive leaks

  Safe

  At Risk

  N/A

• Seatbelt Use

  Safe

  At Risk

  N/A

• 3 points of contact on/off

  Safe

  At Risk

  N/A

• Load capacity chart posted in cab

  Safe

  At Risk

  N/A

• 20' away from power lines

  Safe

  At Risk

  N/A

• Cab glass and wipers in good condition

  Safe

  At Risk

  N/A

• Charged fire extinguisher

  Safe

  At Risk

  N/A

General

• Employees protected from cave-ins and loose rock/soil

  Safe

  At Risk

  N/A

• Spoils at least 2' back from edge of excavation

  Safe

  At Risk

  N/A

• Trench boxes being used if needed

  Safe

  At Risk

  N/A

• Adequate signs posted and barricades provided

  Safe

  At Risk

  N/A

• Housekeeping in good shape

  Safe

  At Risk

  N/A

Utilities

• Utility company contacted or utilities already marked

  Safe

  At Risk

  N/A

Wet conditions

• Dewatering is being done

  Safe

  At Risk

  N/A

• Inspection made after every rainstorm or snow

  Safe

  At Risk

  N/A

Hazardous Atmospheres

• Air in the excavation tested for O2 deficiency, combustibles, etc

  Safe

  At Risk

  N/A

• Ventilation provided if necessary

  Safe

  At Risk

  N/A

• Emergency equipment available

  Safe

  At Risk

  N/A

• Safety harness and life line being used properly

  Safe

  At Risk

  N/A

• Supplied air necessary

  Safe

  At Risk

  N/A

Entry and Exit

• Exit no further than 25' from any employee

  Safe

  At Risk

  N/A

• Ladders secured and extend 3' above the edge go the trench

  Safe

  At Risk

  N/A

• Employees protected from cave ins when entering and exiting

  Safe

  At Risk

  N/A

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign