Title Page
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Site conducted
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Client / Site
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Job No.
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Project Name
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Project Location
- Gate 1
- Gate 2
- Gate 2.5
- Gate 3
- Road
- River
- House Curtilage
- Lake
- Wetlands
- Cascades
- Tip
- Helipad
- Stables
- EWC1
- EWC2
- G3 South
- G3 North
- Marquee
- Service Yard
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Conducted on
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Permit To Dig available
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Permit No.
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Scan/Picture
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Trench Location
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Add media
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Prepared by
Excavation & Earthworks Information
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Project description
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Purpose of Trenching
- Land Drainage
- Storm Drainage
- Irrigation
- Foul/Sewer
- Water Main
- Gas Main
- Power Cable
- Service Trench
- Fibre Optic/Data
- Other
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Enter other purpose
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Excavation Depth
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Excavation Width
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Take photo of the excavation area
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Excavation tools and machines used
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Has all heavy equipment undergone safety checks?
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Approximate Temperature
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Weather
- Rain
- Stormy
- Cloudy
- Windy
- Sunny
- Hot
- Dry
- Wet
- Foggy
- Snow
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Soil Type
- Stable rock
- Clay
- Sand
- Silt
- Gravel
- Constructed Layers (Concrete, Tarmac, Stone Base)
- Peat
- Chalk/Limestone
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Soil Condition
- Firm
- Stiff
- Hard
- Soft
- Moist
- Damp
- Fragmented
- Loose
- Mobile
- Saturated
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Protective System
- None required
- Reduced Dig
- Sloping/Battered Back
- Stepped Formation (Min. 1 m every 1 m)
- Trench shield (box)
- Sheet Pile
- Timber Shoring
- Other
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Enter other protective system
Jobsite Inspection
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Competent person has the authority to remove employees from the excavation immediately.
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Excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work.
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Surface obstructions or structures removed or supported.
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Spoils, materials, and equipment set back at least 1 m from the edge of the excavation.
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Barriers provided at all remotely located excavations, wells, pits, shafts, etc.
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Walkways and bridges over excavations are equipped with standard guardrails and toeboards.
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Warning system established and utilized when mobile equipment is operating near the edge of the excavation.
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Operatives protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation.
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Operatives required to stand away from vehicles being loaded or unloaded.
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Operatives prohibited from going under suspended loads.
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Operatives prohibited from working on the faces of slopes or benched excavations above other employees.
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Hard Hats and Safety Boots worn by all employees.
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Highly visible clothing provided and worn by all employees.
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Gloves & Safety Glasses provided and worn by all employees
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Hearing Protection provided if required
Utilities
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Utility companies contacted and/or Service Plans assessed and all utilities located.
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Exact location of utilities marked.
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CAT Scan undertaken
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Underground installations protected, supported, or removed when excavation is open.
Entry and Exit
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Safe egress throughout excavations 1 m or more in depth.
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Ladders used in excavations secured and extended three feet above the edge of the trench.
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Structural ramps used by employees designed by a competent person.
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Structural ramps used for equipment designed by a registered professional engineer TW
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Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with no-slip surface.
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Employees protected from cave-ins when entering or exiting the excavation.
Wet Conditions
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Precautions take to protect employees from the accumulation of water.
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Water removal equipment monitored by a competent person.
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Surface water or runoff diverted or controlled to prevent accumulation in the excavation.
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Inspections made after every rainstorm or other hazard-increasing occurrence.
Hazardous Atmosphere
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Atmosphere within the excavation tested where there is a reasonable possibility of an oxygen deficiency, combustible or other harmful contaminant exposing employees to a hazard.
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Adequate precautions taken to protect employees from exposure to an atmosphere containing less than 19.5% oxygen and/or to other hazardous atmospheres
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Ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas.
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Testing conducted often to ensure that the atmosphere remains safe.
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Emergency equipment, such as breathing apparatus, safety harness and lifeline, and/or basket stretcher readily available where hazardous atmospheres could or do exist.
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Employees trained to use personal protective and other rescue equipment.
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Safety harness and lifeline used and individually attended when entering bell bottom or other deep confined excavations
Support Systems
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Materials and/or equipment for support systems selected based on soil analysis, trench depth, and expected loads.
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Materials and equipment used for protective systems inspected and in good condition.
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Materials and equipment not in good condition have been removed from service.
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Damaged materials and equipment used for protective systems inspected by a registered professional engineer (RPE) after repairs and before being placed back into service.
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Protective systems installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment.
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Members of support system securely fastened to prevent failure.
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Support systems provided in ensure stability of adjacent structures, buildings, roadways, sidewalks, walls, etc.
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Excavations below the level of the base or footing supported, approved by an RPE.
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Removal of support systems progresses from the bottom and members are released lowly as to note any indication of possible failure.
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Backfilling progresses with removal of support system.
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Excavation of material to a level no greater than two feet below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth.
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Shield system placed to prevent lateral movement.
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Employees are prohibited from remaining in shield system during vertical movement.
Recommendations
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Enter recommendations here
Completion
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Full Name and Signature of Competent Person
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Full Name and Signature of Inspector
