Title Page

  • Client / Site

  • Location
  • Conducted on

  • Prepared by

Spoil Placement

  • Are spoils at least 2 feet back from the excavation?

  • If spoils are not 2 feet back, do you use retaining devices, such as a trench box, to protect the excavation site?

  • Are the spoils placed so that rainwater and other run-off move away from the excavation?

  • If spoils can’t be placed safely at the excavation site, are they hauled to another location?

Protection Systems

  • Has a competent person selected the site’s protection system?

  • Has a competent person overseen the installation of the protection system?

  • Is the protection system accurate for the soil type?

  • Is the protection system inspected every day by the competent person?

Safe Entry and Exit

  • Do all workers have a safe way to enter and exit if the excavation is 4 or more feet deep?

  • Is access within 25 lateral feet of workers?

  • Are access ramps designed by a competent person?

  • Do ramps have a non-slip surface?

  • Do all workers walk upright on an earthen ramp?

  • Are ladders secured?

  • Do ladders extend at least 36 inches above the landing?

  • Do all workers avoid using metal ladders if electricity is present at the site?

Vehicle Safety

  • Do all workers wear a warning vest marked with or made of reflectorized or high visibility materials?

  • Is there a trained flag person who designates traffic at the excavation site?

  • Are all workers trained to use hand or mechanical signals as a way to communicate?

  • Is the excavation site fenced and barricaded at night?

  • Does mobile equipment have a warning system?

Surface Crossing

  • If there is a vehicle crossing, is it designed and installed under the supervision of a registered professional engineer?

  • Do walkways have a minimum clear width of 20 inches?

  • Are walkways fitted with handrails?

  • Do walkways extend a minimum of 24 inches past the surface edge of the trench?

Water Management

  • If there is water, does the site have special support or shield systems approved by a registered professional engineer?

  • Does the site have water removal equipment, such as pumps, used and monitored by a competent person?

  • Are surface waters diverted from the excavation?

  • Do all workers use safety harnesses or lifelines?

  • Are employees required to leave the site during rainstorms?

  • Is the site carefully inspected by a competent person after each rain and before employees are permitted to re-enter?

Hazardous Atmosphere

  • Is the atmosphere tested for possible oxygen deficiency or build-up?

  • Is the oxygen content maintained at between 19.5% and 21%?

  • Is ventilation provided to prevent flammable gas build-up to 20% of lower explosive limit of the gas?

  • Is emergency response equipment readily available?

Inspections

  • Is the excavation site inspected by a competent person?

  • Is the site inspected daily and before the start of each shift?

  • Is site inspected after rainstorms?

  • Is the site inspected after other events that could increase hazards such as snowstorms, windstorms, thaws or earthquakes?

  • Is the site inspected when fissures, cracks, sloughing, undercutting, water seepage or bulging at the bottom occur?

  • Is the site inspected when there is a change in the size, location or placement of the spoil pile?

  • Is the site inspected when there is indication of change or movement in adjacent structures?

  • Are site inspections documented?

General Safety Practices

  • Are all workers wearing hard hats at all times?

  • Do all workers avoid working or walking under a suspended load?

  • Do all workers avoid working on faces of sloped or benched excavations above other employees?

Recommendation

  • List recommendations here

Completion

  • Full Name and Signature of Inspector

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