Title Page

  • Project

  • Form Completed By

  • Location
  • Date / Time

  • Is there a nominated buried services coordinator, and if so, are they aware of the works being carried out?

  • Stop works

  • Are materials, spoil or plant stored away from the edge of the excavation in order to reduce the likelihood of a collapse of the side?

  • Stop works

  • Are properly secured stop blocks provided to prevent tipping vehicles falling in?

  • Stop works

  • Are there guardrails or other equivalent edge protection to stop people falling in?

  • Stop works

  • If the sides of the excavation are sloped back, battered or stepped, is the angle of batter sufficient to prevent collapse?

  • Stop works

  • Is a safe method used for putting in the support, i.e. one that does not rely on people working within an unsupported trench?

  • Stop works

  • Is the excavation inspected by a competent person at the start of every shift; and after any accidental collapse or event likely to have affected its stability?

  • Stop works

  • Is there a safe system of work and permit to break ground in place?

  • Stop works

  • Is there safe access/ egress to the excavation, e.g by a sufficiently long secured ladder?

  • Stop works

  • If hand digging is being carried out, are insulated tools being used?

  • Stop works

  • If using an excavator, are toothless buckets being used to avoid damaging undetected utilities & services?

  • Stop works

  • Has CAT & Genny been used to detect utilities & services?

  • Stop works

  • If working near utilities/services, are flame retardant overalls being used?

  • Stop works

  • Has a procedure/Hold point been identified that details what measures should be taken if unidentified services are discovered? e.g. Stopping works and informing the buried services coordinator

  • Stop works

  • Are suitable exclusion zones in place?

  • Stop works

Sign Off

  • Inspection carried out by

  • Additional Attendees to Inspection
  • Additional attendees to inspection

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