Information

  • Location

  • Conducted on

  • Prepared by

  • Document No.

Introduction

  • Project / Site Name

  • Excavation Scope and volume

  • Has the Competent Person had training in excavation and trench safety?

  • Name of Competent Person

Soil Analysis

  • Is soil analysis and classification required prior to excavation?

  • Has the Competent Person had training in, are knowledgable about soil analysis

  • Soil analysis method used

  • Soil classification

  • Select soil characteristics (select all that apply)

  • Are any soil contaminants present?

  • Detail soil contaminants and quantity

General

  • Has a Risk Assessment been completed by a Competent Person?

  • When are excavations, adjacent areas, and protective systems inspected by a competent person?

  • Underground utilities located, marked and noted, with operator and relevant personnel informed?

  • Is Traffic Control in place where required?

  • Are hard hats and all other appropriate PPE worn by all employees?

  • Are all employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation?

  • Are barriers provided at all remotely located excavations, wells, pits, shafts, etc.?

  • Are walkways and bridges over excavations equipped with standard guard rails and toe-boards?

Protective and Support Systems

  • Type of protective system being used?

  • Protective system appropriate for soil type, trench size and expected loads?

  • Have materials and equipment used for protective / support systems been inspected by the Competent Person and found to be in good condition?

Access & Egress

  • Are there safe means of egress regularly spaced across space of excavation?

  • Walkways, bridges, ladders and ramps are in safe, secure positions?

  • Are all personnel reasonably able to use access and egress?

  • Are all personnel familiar with emergency, rescue and evacuation procedures?

Sign Off

  • Name & Signature of Competent Person

  • Name & Signature of Site Foreman / Supervisor

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.