JMW Excavation/Trench Inspection

• Document No.

• Project Name

• Project Number

• Conducted on

  Date

• Prepared by

• Location
  Address

What is the name of the competent person?

Weather

• Describe the weather conditions.

  Select Clear Rain Snow Ice

  • Clear
  • Rain
  • Snow
  • Ice

• What is the temperature?

• Comments

Purpose of 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

• Comments

What are the 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

Soil Type

• 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 Solid rock Average soil Fill material Loose sand

  • Solid rock
  • Average soil
  • Fill material
  • Loose sand

• Comments

Protection Methods

• What type of protection method was used

  Select Shoring Trench Box Sloping

  • Shoring
  • Trench Box
  • Sloping

• Add job site photo here:

  Media

• Comments

Hazardous Conditions

• Is there surface drainage?

  Yes

  No

  N/A

• Is the excavation/trench below the water table?

  Yes

  No

  N/A

• Is there anything causing vibration near the excavation/trench?

  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

• Is there any other construction activities near the excavation/trench?

  Yes

  No

  N/A

• Is the excavation/trench safe to enter?

  Yes

  No

  N/A

• Are there any hazardous atmospheres?

  Yes

  No

  N/A

• Add extra photos here:

  Media

• Comments

• Competent Person Signature

  Sign