GCC Excavation/Trench Inspection

• Document No.

• Project Name

• Project Number

• Conducted on

  Date

• Prepared by

• Location
  Address

Weather

• Describe the weather conditions.

  Select Clear Rain Snow Ice

  • Clear
  • Rain
  • Snow
  • Ice

• What is the temperature?

• Comments

Excavation/trench

• What is the purpose of the excavation/trench?

  Select Drainage Sewer Water Gas Other

  • Drainage
  • Sewer
  • Water
  • Gas
  • Other

• Have all the utilities been notified? (call 811)

  Yes

  No

  N/A

• What is the utility locate number?

• Comments

Dimensions of the excavation/trench?

• What is the depth of the excavation/trench?

• What is the length & width of the excavation/trench at the bottom?

• What is the length & width of the excavation/trench at the top?

• Comments

• What is the name of the competent person?

Soil

• Has the soil been tested?

  Yes

  No

  N/A

• Who or what organization performed the soil test?

• What type of soil classification resulted from the test?

  Select Type A Soil Type B Soil Type C Soil

  • Type A Soil
  • Type B Soil
  • Type C Soil

• Comments

Protection Methods

• What type of protection method was used?

  Select Shoring Trench Box Sloping

  • Shoring
  • Trench Box
  • Sloping

• Comments

Hazardous Conditions

• Has surface drainage been properly managed?j

  Yes

  No

  N/A

• Is the excavation/trench above the water table?

  Yes

  No

  N/A

• Has vibration near the excavation/trench been properly managed?

  Yes

  No

  N/A

• Are the spoil piles at least 2 feet from the edge of the trench?

  Yes

  No

  N/A

• Is there a means of access & egress within 25 feet of safe travel?

  Yes

  No

  N/A

• Does the ladder extend at least 3 feet above the landing?

  Yes

  No

  N/A

• Have all other construction activities near the excavation/trench been properly managed?

  Yes

  No

  N/A

• Have the hazardous atmospheres been properly managed?

  Yes

  No

  N/A

• Is the excavation/trench safe to enter?

  Yes

  No

  N/A

• Comments

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