Title Page

  • Location / Site

  • Prepared by

  • Conducted on


  • Safe access and egress provided ie adequate ramps

  • Rigid guardrails, barricading or paraweb around all excavations.

  • Spoil distance from excavation to be equal to depth

  • Valid clearance in place.

  • Excavations deeper than 1.5m – side benches / battered / trench shields. Mines Dept. notifed

  • Fumes from Plant / Equipment not entering excavation.

  • SWMS in place and specific to task undertaken

  • Flashing lights / reflective tape on barricading erected on roadways and access ways.

  • Barricading maintained and in good condition.

  • Correct PPE being used for the task.

  • Prestart inspection of excavation been conducted.

  • Operator competencies verified

  • Other findings:


  • Name:

  • Select date

  • Signature:

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