MMA - Trenching/Excavation Inspection

• Prepared by

• Conducted on

  Date

• Prepared for

• Project Name:

• Add location
  Address

• Marsh & McLennan Agency (MMA) provides assistance to employers in evaluating workplace safety exposures and/or conducting surveys, which may not reveal every hazard, exposure and/or violation of safety practices. Inspections conducted by MMA do not result in any guarantee that the workplace, operations, machinery, appliances or equipment are safe or in compliance with applicable regulations. Appropriate protection is ultimately the responsibility of the employer. This report may contain confidential information.

• The services performed by MMA on this project have been conducted with that level of care or skill ordinarily exercised by reputable members of the profession, practicing in the same locality under similar budget and time constraints. No other warranty is expressed or implied.

• This report is intended for the sole use of MMA’s client. This report may not be used or relied upon by any other party without the written consent of MMA. The scope of services performed in execution of the evaluation may not be appropriate to satisfy the needs of other users, and the use or re-use of this document or the findings, conclusions, or recommendations is at the risk of said user.

SITE SUMMARY:

• Add media

  Media

PPE:

• Personal Protective Equipment being worn as required (Hard Hats, Safety Glasses, High Visibility Clothing, Face Shield, Other)

  Safe

  At Risk

  N/A

UTILITY LOCATES:

• Notification process completed (Called 811 a minimum of 48 hours notice excluding holidays/weekends, request made up to 14 days in advance, white excavation boundary markings complete)

  Safe

  At Risk

  N/A

• Locate ticket verified before digging (status checked using ITIC system or by calling 811)

  Safe

  At Risk

  N/A

• Facility operator has marked the excavation site before digging

  Safe

  At Risk

  N/A

• 

• Utility locate marks are maintained, and refreshed within 14 calendar days

  Safe

  At Risk

  N/A

• A minimum horizontal (side to side) clearnace of 2 feet between utility and cutting edge of power operated equipment is maintained

  Safe

  At Risk

  N/A
EXCAVATION REQUIREMENTS:

• Description

• Approximate Excavation Dimensions (Length, Width, Depth)

• Protective system in use:

  Select Sloping Benching Shoring Trench Box

  • Sloping
  • Benching
  • Shoring
  • Trench Box

Soil Classification

• Visual Analysis of Soil:

  Select Soil remains in clumps-Cohesive Soil breaks up easily-Granular

  • Soil remains in clumps-Cohesive
  • Soil breaks up easily-Granular

• What method did the competent person use to classify the soil?

  Plasticity Test

  Thumb Penetration Test

  Penetrometer Test

  Unable to Verify

  Other

• What was the soil classified as?

  Select Stable Rock Soil Type A 1.5 tons/ft2 or greater (cohesive soil previously undistrubed - clay, silty/sandy clay, clay loam) Soil Type B 0.5-1.5 tons/ft2 (cohesive soil and granular cohesionless soils - angular gravel, crushed rock, silt, silt loam, sandy loam) Soil Type C 0.5 tons/ft2 or less (cohesive soil or granular soil, submerged soil - gravel, sand, loamy sand, unstable rock, wet soil)

  • Stable Rock
  • Soil Type A 1.5 tons/ft2 or greater (cohesive soil previously undistrubed - clay, silty/sandy clay, clay loam)
  • Soil Type B 0.5-1.5 tons/ft2 (cohesive soil and granular cohesionless soils - angular gravel, crushed rock, silt, silt loam, sandy loam)
  • Soil Type C 0.5 tons/ft2 or less (cohesive soil or granular soil, submerged soil - gravel, sand, loamy sand, unstable rock, wet soil)

Excavation Checklist 4' to 20' depth (if over 20' must be engineered)

• Excavations and protective systems inspected by Competent Person daily, before start of work?

  Yes

  No

  N/A

• Protective system in place in an excavation over 5' ft in depth (support systems, sloping and benching systems, shield systems, and other systems)?

  Yes

  No

  N/A

• Excavation properly sloped/benched per soil classification?<br> STABLE ROCK = VERTICAL (90º)<br> TYPE A = 3/4:1 (53º)<br> TYPE B = 1:1 (45º)<br> TYPE C = 1 ½:1 (34º) , CAN NOT BE BENCHED<br><br><br>

  Yes

  No

  N/A

• Spoils, materials, and equipment set back a minimum of 2 ft from edge of excavation?

  Yes

  No

  N/A

• Ladders provided every 25 ft laterally from each worker in excavations over 4' ft in depth?

  Yes

  No

  N/A

• Top of ladders 3' ft or more above grade?

  Yes

  No

  N/A

• Competent Person has authority to remove workers from excavation immediately?

  Yes

  No

  N/A

• Traffic Control in place if required?

  Yes

  No

  N/A

• Have site specific hazards been noted?

  Yes

  No

  N/A

• Surface encumbrances supported or removed?

  Yes

  No

  N/A

• Employees protected from loose rock or soil?

  Yes

  No

  N/A

• Barriers provided at all remote excavations, wells, pits, shafts, etc..?

  Yes

  No

  N/A

• Walkways and bridges over excavations 6' ft or more in depth equipped with guard rails?

  Yes

  No

  N/A

• Employees prohibited from walking under suspended loads?

  Yes

  No

  N/A

• Is trench box labelled and in proper condition?

  Yes

  No

  N/A

• Trucks & delivery drivers advised to stay back 20' ft from excavation?

  Yes

  No

  N/A

• Excavations protected if required to be left open overnight?

  Yes

  No

  N/A

Utilities

• Utility companies contacted and/or located?

  Yes

  No

  N/A

• Utilities marked?

  Yes

  No

  N/A

• Are utilities supported?

  Yes

  No

  N/A

Wet Conditions

• Cautions taken to protect employees from accumulation of water?

  Yes

  No

  N/A

• Water removal equipment monitored?

  Yes

  No

  N/A

• Surface water controlled or diverted?

  Yes

  No

  N/A

• Inspection made after each rainstorm?

  Yes

  No

  N/A

Hazardous Atmosphere

• Excavation greater than 4' ?

  Yes

  No

  N/A

• Is there reasonable possibility of an oxygen deficiency, combustible or other harmful contaminant exposing employees to a hazard?

  Yes

  No

  N/A

• Oxygen content between 19.5% and 21%?

  Yes

  No

  N/A

• Testing conducted to ensure that atmosphere remains safe?

  Yes

  No

  N/A

• Emergency equipment readily available where a hazardous atmosphere could or does exist?

  Yes

  No

  N/A

• Employees trained in the use of personal protective an emergency response equipment?

  Yes

  No

  N/A

• Safety harness and life line individually attended when employees enter permit required confined space?

  Yes

  No

  N/A

• Include photographs of the testing equipment and emergency response equipment.

  Media

ADDITIONAL REQUIREMENTS

• EMERGENCY RESPONSE: First Aid/CPR available at the jobsite and/or EMS Response within 4 minutes. System in place to be able to communicate a jobsite emergency (use of air horn, etc.). Local emergency contact information available (hospital/clinic). Eye wash capable of providing 15 minutes of flushing available on site for caustic/corrosive operations (portland cement).

  Safe

  At Risk

  N/A

• MNOSHA 5207.1000: Excavation Contractor and personnel are trained, Joint contractor safety awareness meeting held to discuss how to approach equipment (visual, voice, or signal), maintaining visibility while approaching (high visibility garments), operator responsibilities, pre use inspections, overhead and underground utilities, equipment blind spots, safe operating procedures of equipment (traveling, backing, parking, loading for transport, maintenance, and operation).

  Safe

  At Risk

  N/A

• PUBLIC SAFETY PROTECTION: Sufficient measures in place based on the potential risk to the general pubic such as Barricades, Fencing, Signage, Pedestrian Access, Curb Ramps, Detours, etc.

  Safe

  At Risk

  N/A

• SILICA: Tasks creating a respirable crystalline silica hazard (concrete dust) have controls in place to mitigate dust (dust collection system, water delivery system). Tools and equipment are compliance with OSHA Table 1, or alternative methods. If relying on alternative methods, objective data or exposure assessment information is available. A Silica Exposure Control Plan been created for each activity by contractor performing the work.

  Select Safe At Risk N/A

  • Safe
  • At Risk
  • N/A

• Is Table 1 being used for compliance with the Silica standard?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Include a summary of tasks and method of compliance (exposure study, objective data, etc.)

• Which Table 1 tools are in use?

  Select Stationary Masonry Saw Handheld Power Saw Handheld Saw for cutting fiber-cement siding Walk-behind saws Driveable saws Rig-mounted core saws or drills Handheld and Stand Mounted Drills (Rotary Hammer/Impact) Dowel drilling rigs Vehicle mounted drilling rigs for rock/concrete Jackhammers and chipping tools Griders, used for Tuckpointing Grinders, other uses Walk hehind milling machines and floor grinders Small driveable milling machines Large Driveable Milling Machines Crushing Machines Heavy equipment used for abrad/fracture/demo Heavy equipment used for excavation

  • Stationary Masonry Saw
  • Handheld Power Saw
  • Handheld Saw for cutting fiber-cement siding
  • Walk-behind saws
  • Driveable saws
  • Rig-mounted core saws or drills
  • Handheld and Stand Mounted Drills (Rotary Hammer/Impact)
  • Dowel drilling rigs
  • Vehicle mounted drilling rigs for rock/concrete
  • Jackhammers and chipping tools
  • Griders, used for Tuckpointing
  • Grinders, other uses
  • Walk hehind milling machines and floor grinders
  • Small driveable milling machines
  • Large Driveable Milling Machines
  • Crushing Machines
  • Heavy equipment used for abrad/fracture/demo
  • Heavy equipment used for excavation

• Engineering Control: Water delivery system required
  Respirator: Not required, regardless of location or duration.

• Engineering Control: Water delivery system required
  Respirator: Not required outdoors less than 4 hours/shift. Required outdoors greater than 4 hours/shift, or indoors regardless of duration (APF10).

• Engineering Control: Water delivery system required
  Respirator: Not required outdoors less than 4 hours/shift. Required outdoors greater than 4 hours/shift, or indoors regardless of duration.

• Outdoor use only
  Engineering Control: Dust collection system required
  Respirator: Not required outdoors regardless of duration.

• Engineering Control: Water delivery system required
  Respirator: Not required outdoors regardless of duration. Required indoors (APF 10).

• Outdoor use only
  Engineering Control: Water delivery system required
  Respirator: Not required outdoors regardless of duration.

• Engineering Control: Water delivery system required
  Respirator: Not required regardless of location or duration.

• Engineering Control: Dust collection system required
  Respirator: Not required regardless of location or duration.

• Outdoor use only
  Engineering Control: Dust collection system required
  Respirator: Required regardless of duration (APF10).

• Engineering Control: Dust collection system with close capture hood/shroud, or operate from enclosed cab with water or dust suppression on drill bit.
  Respirator: Not required regardless of duration.

• Engineering Control: Water delivery system or Dust collection system required
  Respirator: Not required, outdoors less than 4 hours/shift. Required outdoors greater than 4 hours/shift, or indoors regardless of duration.

• Engineering Control: Dust collection system required
  Respirator: Required, if less than 4 hours/shift (APF10) or more than 4 hours/shift (APF25).

• Engineering Control: Dust collection (Indoors/outdoors) or water delivery system (outdoors only)
  Respirator: Not required outdoors with water delivery or dust collection regardless of duration. Required indoors with dust collection greater than 4 hours/shift (APF10)

• Engineering Control: Dust collection or water delivery system required
  Respirator: Not required regardless of location or duration.

• For cuts of any depth on asphalt only:
  Engineering Control: Dust collection and water delivery system required
  Respirator: Not required regardless of duration.

• Engineering Control: Water delivery system required
  Respirator: Not required regardless of duration.

• Engineering Control: Enclosed cab or wet material to minimize dust
  Respirator: Not required regardless of duration.

• Engineering Control: Enclosed cab or wet material to minimize dust
  Respirator: Not required regardless of duration.

• Any other concerns or hazards identified on the jobsite?

  Yes

  No

• Include a summary of the hazard and mitigation plan.

• Any examples of best practices, or pro-active safety efforts observed during the site visit?

  Yes

  No

• Explain:

• Are there any safety meetings/toolbox talks being held on the jobsite?

  Yes

  No

• Are they being documented?

  Yes

  No