Holland Safety Excavation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Excavations

• Access with 25'

  Safe

  At Risk

  N/A

• Competent person present

  Safe

  At Risk

  N/A

• Daily inspections documented

  Safe

  At Risk

  N/A

• Excavation > 20' engineered

  Safe

  At Risk

  N/A

• One Call system used

  Safe

  At Risk

  N/A

• Perimeter protection/barricade

  Safe

  At Risk

  N/A

• Sloped, benched, or shored

  Safe

  At Risk

  N/A

• Spoil 2' from edge

  Safe

  At Risk

  N/A

• Surface encumbrances

  Safe

  At Risk

  N/A

• Surface traffic exposure

  Safe

  At Risk

  N/A

• Water entering excavation

  Safe

  At Risk

  N/A