RGW Construction Trench Safety Field Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• WEATHER CONDITIONS (note: hit "yes" twice and fill out conditions in drop down box)

  Yes

  No

  N/A

• RAINFALL AMOUNTS 24 HOURS PREVIOUS (note: hit "yes" twice and fill in amount in drop down box)

  Yes

  No

  N/A

• I hereby attest that the following conditions existed and that the following items were checked or reviewed during the inspection. (For questions with a letter in parenthesis at the end additional information is needed if the corresponding box was checked.)

• 1. Underground Service Alert contact number(s): (note: hit "yes" twice and write the number in the drop down box)

  Yes

  No

  N/A

• 2. All open trench inspected (N)

  Yes

  No

  N/A

• 3. All surcharge located proper distance from toe of slope (N)

  Yes

  No

  N/A

• 4. Any tension cracks observed along the top of any slopes? (Y)

  Yes

  No

  N/A

• 5. Slope cut at design angle of repose? (N)

  Yes

  No

  N/A

• 6. Water seepage noted in trench walls or bottom? (Y)

  Yes

  No

  N/A

• 7. Bracing system installed in accordance with design? (N)

  Yes

  No

  N/A

• 8. Evidence of shrinkage cracks in trench walls? (Y)

  Yes

  No

  N/A

• 9. Evidence of caving or sloughing of soil since the last field inspection? (Y)

  Yes

  No

  N/A

• 10. Any zones of usually weak soils or materials not anticipated? (Y)

  Yes

  No

  N/A

• 11. Evidence of significant fracture planes in soil or rock? (Y)

  Yes

  No

  N/A

• 12. All short-term trenches covered within 24 hours? (N)

  Yes

  No

  N/A

• 13. Noncompliance items photographed? (N)

  Yes

  No

  N/A

• 14. Trench box(s) certified? (N) Shield capacity in lbs/sqft: (note: hit appropriate answer twice and fill out capacity in drop down box)

  Yes

  No

  N/A

• 15. Hydraulic shores pumped to design pressure? (N)

  Yes

  No

  N/A

• 16. Is shoring secure? (N)

  Yes

  No

  N/A

• 17. Type of shoring used: (note: hit "yes" twice and fill out type in drop down box)

  Yes

  No

  N/A

• 18. Shoring plan included adequate safety factor to allow for equipment being used? (N)

  Yes

  No

  N/A

• 19. Trenches protected with barricades from traffic in area? (N)

  Yes

  No

  N/A

• 20. Trees, boulders, or other hazards in area? (Y)

  Yes

  No

  N/A

• 21. Vibrations from equipment or traffic too close to trenching operation? (Y)

  Yes

  No

  N/A

• 22. Changed subsurface conditions from those anticipated? (Y)

  Yes

  No

  N/A

TRENCH CONDITIONS

• 23. Width of trenches at bottom? (note: hit "yes" twice and fill out width in drop down box)

  Yes

  No

  N/A

• 24. Maximum depth of trenches? (note: hit "yes" twice and fill out depth in drop down box)

  Yes

  No

  N/A

• 25. Soil type?

  A

  B

  C

PROTECTION SYSTEM

• 26. Select type of protection used

  Select Sloped Side Benching Hydraulic Shores Trench Shield Other None

  • Sloped Side
  • Benching
  • Hydraulic Shores
  • Trench Shield
  • Other
  • None

• If other hit "Yes" twice and fill in type of protection used. Otherwise hit N/A.

  Yes

  No

  N/A

• 27. Sloping and benching- select angle of repose

  1/2:1

  3/4:1

  1:1

  Other

• If other hit "Yes" twice and fill in angle of repose

  Yes

  No

  N/A

SECURITY PROTECTION

• 28. Protection provided during weekends and evenings after crew left site? (N)

  Yes

  No

  N/A

• 29. Steel plates for road crossing? (N)

  Yes

  No

  N/A

• 30. Barricading roadway, sidewalks, and excavations? (N)

  Yes

  No

  N/A

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