Title Page
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Client / Site
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Location
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Conducted on
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Prepared by
Spoil Placement
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Are spoils at least 2 feet back from the excavation?
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If spoils are not 2 feet back, do you use retaining devices, such as a trench box, to protect the excavation site?
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Are the spoils placed so that rainwater and other run-off move away from the excavation?
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If spoils can’t be placed safely at the excavation site, are they hauled to another location?
Protection Systems
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Has a competent person selected the site’s protection system?
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Has a competent person overseen the installation of the protection system?
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Is the protection system accurate for the soil type?
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Is the protection system inspected every day by the competent person?
Safe Entry and Exit
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Do all workers have a safe way to enter and exit if the excavation is 4 or more feet deep?
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Is access within 25 lateral feet of workers?
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Are access ramps designed by a competent person?
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Do ramps have a non-slip surface?
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Do all workers walk upright on an earthen ramp?
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Are ladders secured?
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Do ladders extend at least 36 inches above the landing?
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Do all workers avoid using metal ladders if electricity is present at the site?
Vehicle Safety
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Do all workers wear a warning vest marked with or made of reflectorized or high visibility materials?
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Is there a trained flag person who designates traffic at the excavation site?
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Are all workers trained to use hand or mechanical signals as a way to communicate?
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Is the excavation site fenced and barricaded at night?
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Does mobile equipment have a warning system?
Surface Crossing
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If there is a vehicle crossing, is it designed and installed under the supervision of a registered professional engineer?
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Do walkways have a minimum clear width of 20 inches?
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Are walkways fitted with handrails?
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Do walkways extend a minimum of 24 inches past the surface edge of the trench?
Water Management
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If there is water, does the site have special support or shield systems approved by a registered professional engineer?
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Does the site have water removal equipment, such as pumps, used and monitored by a competent person?
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Are surface waters diverted from the excavation?
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Do all workers use safety harnesses or lifelines?
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Are employees required to leave the site during rainstorms?
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Is the site carefully inspected by a competent person after each rain and before employees are permitted to re-enter?
Hazardous Atmosphere
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Is the atmosphere tested for possible oxygen deficiency or build-up?
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Is the oxygen content maintained at between 19.5% and 21%?
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Is ventilation provided to prevent flammable gas build-up to 20% of lower explosive limit of the gas?
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Is emergency response equipment readily available?
Inspections
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Is the excavation site inspected by a competent person?
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Is the site inspected daily and before the start of each shift?
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Is site inspected after rainstorms?
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Is the site inspected after other events that could increase hazards such as snowstorms, windstorms, thaws or earthquakes?
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Is the site inspected when fissures, cracks, sloughing, undercutting, water seepage or bulging at the bottom occur?
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Is the site inspected when there is a change in the size, location or placement of the spoil pile?
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Is the site inspected when there is indication of change or movement in adjacent structures?
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Are site inspections documented?
General Safety Practices
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Are all workers wearing hard hats at all times?
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Do all workers avoid working or walking under a suspended load?
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Do all workers avoid working on faces of sloped or benched excavations above other employees?
Recommendation
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List recommendations here
Completion
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Full Name and Signature of Inspector