RCSCW, Excavation Report & Inspection

• Document No.

• Site:

• Site Address:

• Conducted on:

  Date

• Prepared by:

• Competent Person:

Site Information:

• Facility:

• Facility Address:

• Dig Location:

• Start Date & Time:

  Date

• Weather Conditions:

• Site Foreman / Competent Person:

• Purpose of Excavation:

• Number of Employees Exposed:

Excavation Report:

• Has the Area been Marked by Blue Stake?<br>ARS - 40.360.22, OSHA - 1926.651(b)

  Yes

  No

  N/A

• Date of Completed Marking:

  Date

• Has the Area been Marked by a Private Locator?

  Yes

  No

  N/A

• Date of Completed Marking:

  Date

• Are Tractor Operators Trained, Certified or Supervised when Operating?<br>OSHA 1910-178(L)

  Yes

  No

  N/A

• Are Seat Belts and or Roll Protection being Used?

  Yes

  No

  N/A

• Are Pedestrians & Traffic Protected from Open Trenches?

  Yes

  No

  N/A

• Are Employees Protected from Traffic?<br>OSHA 1926-651(d)

  Yes

  No

  N/A

• Have Surface Obstructions & Encumbrances been Removed?<br>OSHA 1926-651(a)

  Yes

  No

  N/A

• Is Trench Properly Sloped / Shored?<br>(1.5 to 1, Max. Depth 20')<br>OSHA 1926 Sub. P, App. B

  Yes

  No

  N/A

• Is Access / Egress Maintained?<br>(At or Below 4' Depth)<br>OSHA 1926-651(c)(1)

  Yes

  No

  N/A

• Air Quality Test Performed?<br>(4' Depth and Below)<br>OSHA 1926-651(g)

  Yes

  No

  N/A

• Fall Protection Required?<br>(Required for Trench 6' and Deeper)<br>ADOSH

  Yes

  No

  N/A

• Has Water been Removed Prior to work being performed? <br>OSHA 1926-651(h)

  Yes

  No

  N/A

• Are Tolerance Zones being Maintained?<br>(Minimum 2 ft. on either side of marks)<br>ARS 40-360.21

  Safe

  At Risk

  N/A

• Is Spoil Pile a Minimum of 2 ft. from Trench?<br>ADOSH

  Yes

  No

  N/A

• Is There a Source of Vibration

  NO

  YES (if yes discribe)

• Are Other Utilities Present?

  NO

  YES (if yes discribe)

• Can Surface Water be Diverted?

  Yes

  No

  N/A

• Daily Inspection by Competent Person?

  Yes

  No

  N/A

Excavation Measurements

• Excavation Depth:

• Top Width:

• Bottom Width:

• Length:

• Slope Length:

• Spoil Pile Distance from Edge:

Soil Type / Condition:

• Soil Type

  Select Type "A" Type "B" Type "C"

  • Type "A"
  • Type "B"
  • Type "C"

• Soil Condition:

  Fine Grained

  Course Grained

  Sand

  Gravel

• If Soil is Layered, Please Discribe:

• Does Excavated Soil Remain in Clumps?

  NO

  YES (if yes discribe)

• Are there Cracks in the Side Walls?

  NO

  YES (if yes discribe)

• Do Chunks Fall Off?

  NO

  YES (if yes discribe)

• Do Spalls Appear?

  NO

  YES (if yes discribe)

• Additional Comments / Special Conditions: