Title Page
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Project
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Form Completed By
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Location
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Date / Time
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Is there a nominated buried services coordinator, and if so, are they aware of the works being carried out?
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Stop works
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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?
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Stop works
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Are properly secured stop blocks provided to prevent tipping vehicles falling in?
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Stop works
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Are there guardrails or other equivalent edge protection to stop people falling in?
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Stop works
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If the sides of the excavation are sloped back, battered or stepped, is the angle of batter sufficient to prevent collapse?
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Stop works
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Is a safe method used for putting in the support, i.e. one that does not rely on people working within an unsupported trench?
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Stop works
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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?
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Stop works
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Is there a safe system of work and permit to break ground in place?
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Stop works
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Is there safe access/ egress to the excavation, e.g by a sufficiently long secured ladder?
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Stop works
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If hand digging is being carried out, are insulated tools being used?
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Stop works
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If using an excavator, are toothless buckets being used to avoid damaging undetected utilities & services?
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Stop works
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Has CAT & Genny been used to detect utilities & services?
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Stop works
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If working near utilities/services, are flame retardant overalls being used?
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Stop works
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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
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Stop works
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Are suitable exclusion zones in place?
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Stop works
Sign Off
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Inspection carried out by
Additional Attendees to Inspection
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Additional attendees to inspection