Progressive Environmental and Safety - Daily Excavation Checklist

• Client

• Project Name

• Project Location
  Address

• Job Number

• Date

  Date

• Safety Representative

• INSTRUCTIONS:
  -------------------------------------
  1. Answer the applicable questions below.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  **NOTE: Trenches over 5 feet in depth are considered excavations. Any items marked NO on this form MUST be remediated prior to any employees entering the excavation.

GENERAL INFORMATION

• Approximate Temperature

• Approximate Wind Direction

• Soil Classification

• Excavation Depth & Width

• Protective System Used

• Activities In Excavation

• Competent Person

• Excavation > 4 feet deep?

  Yes

  No

GENERAL

• Employees protected from cave-ins & loose rock/soil that could roll into the excavation

  Yes

  No

  N/A

• Spoils, materials & equipment set back at least 2 feet from the edge of the excavation.

  Yes

  No

  N/A

• Engineering designs for sheeting &/or manufacturer's data on trench box capabilities on site

  Yes

  No

  N/A

• Adequate signs posted and barricades provided

  Yes

  No

  N/A

• Training (toolbox meeting) conducted w/ employees prior to entering excavation

  Yes

  No

  N/A

UTILITIES

• Utility company contacted & given 72 hours notice &/or utilities already located & marked

  Yes

  No

  N/A

• Overhead lines located, noted and reviewed with the operator

  Yes

  No

  N/A

• Utility locations reviewed with the operator, & precautions taken to ensure contact does not occur

  Yes

  No

  N/A

• Utilities crossing the excavation supported, and protected from falling materials

  Yes

  No

  N/A

• Underground installations protected, supported or removed when excavation is open

  Yes

  No

  N/A

WET CONDITIONS

• Precautions taken to protect employees from water accumulation (continuous dewatering)

  Yes

  No

  N/A

• Surface water or runoff diverted /controlled to prevent accumulation in the excavation

  Yes

  No

  N/A

• Inspection made after every rainstorm or other hazard increasing occurrence

  Yes

  No

  N/A

HAZARDOUS ATMOSPHERES

• Air in the excavation tested for oxygen deficiency, combustibles, other contaminants

  Yes

  No

  N/A

• Ventilation used in atmospheres that are oxygen rich/deficient &/or contains hazardous substances

  Yes

  No

  N/A

• Ventilation provided to keep LEL below 10 %

  Yes

  No

  N/A

• Emergency equipment available where hazardous atmospheres could or do exist

  Yes

  No

  N/A

• Safety harness and lifeline used

  Yes

  No

  N/A

• Supplied air necessary (if yes, contact safety department)

  Yes

  No

  N/A

ENTRY & EXIT

• Exit (i.e. ladder, sloped wall) no further than 25 feet from ANY employee

  Yes

  No

  N/A

• Ladders secured and extend 3 feet above the edge of the trench

  Yes

  No

  N/A

• Wood ramps constructed of uniform material thickness, cleated together @ the bottom

  Yes

  No

  N/A

• Employees protected from cave-ins when entering or exiting the excavation

  Yes

  No

  N/A

COMPLETION

• Audited by

  Sign

• WorkSAFE...Like a Pro!