Excavation Safety Checklist (For Internal Staff )

• Conducted on

  Date
• Location
  Address

• Conducted by

• Competent Person for Project

• Number of employees on job site

• Excavation Depth & Width (Estimated)

• Type of soil (opinion of Loss Control Consultant)

  Select Solid rock Type A Type B Type C Combination Soil

  • Solid rock
  • Type A
  • Type B
  • Type C
  • Combination Soil

• Does the risk conduct weekly tool box meetings<br>

  Yes

  No

  N/A

• Any additional comments

GENERAL INSPECTION

• Have utilities been located and marked<br>

  Yes

  No

  N/A

• Is there at least one competent person currently on the job

  Yes

  No

  N/A

• Does the designated Competent Person have authority to shut the job down

  Yes

  No

  N/A

• Has the Competent Person had specific training in -- and is knowledge about -- soil analysis, use of protective systems

  Yes

  No

  N/A

• Has a daily inspection form been completed by Competent Person<br>

  Yes

  No

  N/A

• Did competent person do a visual test to determine soil type<br>

  Yes

  No

  N/A

• What manual test did the Competent Person do to determine soil type

• Based on the Competent Person's tests, what do they consider the soil type to be

  Solid rock

  Type A

  Type B

  Type C

  Combination Soil

• Does your assessment match the Competent Persons<br>

  Yes

  No

  N/A

• Are excavations, adjacent areas, and protective systems inspected by a competent person:

  Select Daily prior to start of work As needed throughout the shift After every rainstorm or other occurrence that could increase the hazard All of the above

  • Daily prior to start of work
  • As needed throughout the shift
  • After every rainstorm or other occurrence that could increase the hazard
  • All of the above

• If the trench is 5 feet or deeper what protection system is being used (slop, bench, shoring, trench box)

  Sloping

  Benching

  Shoring

  Trench Box

  Other

• If manufactured protective systems are being used, are they in good working condition

  Yes

  No

  N/A

• If trench boxes used are they at least 18” above the soil<br>

  Yes

  No

  N/A

• Are employees prohibited from remaining in a shield system during vertical movement?

  Yes

  No

  N/A

• If sloping or benching used was it at the proper angle and or dimensions<br>

  Yes

  No

  N/A

• If the trench is 4 feet or deeper does it have a means of egress<br>

  Yes

  No

  N/A

• Is the egress no more than 25 feet of lateral travel for employees

  Yes

  No

  N/A

• If ladders are being used for egress do they extend 3 feet above the top<br>

  Yes

  No

  N/A

• If structural ramps being used were they designed by a competent person<br>

  Yes

  No

  N/A

• Are walkways and bridges over excavations 6 feet or more in depth and 30 inches or more in width equipped with standard guard rails and toe-boards?

  Yes

  No

  N/A

• Area surface encumbrances removed or supported (ie: boulders, trees, sidewalks)<br>

  Yes

  No

  N/A

• Are all employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation?

  Yes

  No

  N/A

• Are Hard hats worn by all employees if required

  Yes

  No

  N/A

• Have any underground installations been protected, supported, or removed (ie: piping, conduit, etc.) <br>

  Yes

  No

  N/A

• Has the Competent Person looked for shrinkage cracks on trench wall<br>

  Yes

  No

  N/A

• Are spoiled, materials, and equipment set back at least 2 feet from the edge of your excavation

  Yes

  No

  N/A

• Are highly visible clothing or vest provided and worn by all employees exposed to vehicle traffic?

  Yes

  No

  N/A

• Are warning systems established and used when mobile equipment is operating near the edge of an excavation?

  Yes

  No

  N/A

• Are employees prohibited from going under suspended loads?

  Yes

  No

  N/A

• Are employees prohibited from working on the face of slope or benched excavation above other employees?

  Yes

  No

  N/A

• If there is water in the trench, is appropriate water removal equipment being used and monitored by the Competent Person<br>

  Yes

  No

  N/A

• Is the atmosphere within all excavations tested when there is a reasonable possibility of an oxygen deficiency, oxygen enriched, combustible, toxic, or other harmful contaminant?

  Yes

  No

  N/A

• Are adequate precautions taken to protect employees from exposures to an atmosphere containing less then 19.5% oxygen and or other hazardous atmosphere?

  Yes

  No

  N/A

• Is mobile equipment that could create a sidewall failure a safe distance away <br>

  Yes

  No

  N/A

• Is emergency equipment available when hazardous atmosphere could or do exist?

  Yes

  No

  N/A

• Are employees trained to use personal protective equipment and other rescue equipment?

  Yes

  No

  N/A

• Any additional Comments

Photos of job site

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