Title Page

  • Date Conducted

  • Conducted By

  • Customer Name

  • Job Name

  • Location
  • Duration of Work

  • Has a 'Permit to Dig' been completed?

  • Date & time 'Permit to Dig' completed

Trench / Excavation Inspection

  • Has the need for a Trench Protection system been considered?

  • Please give details

  • Is there trench support available / in place onsite? (shoring, shielding, sloping, benching)

  • Has a ground type / condition assessment been carried out?

  • Who completed this assessment?

  • Is there a way to enter / exit the trench safely? e.g. lader every 6m

  • Has the site Foreman approved the trench for entry?

  • Is there protection of open trenches? e.g. plates, fencing etc.

  • If required, is de-watering equipment available?

  • Is a Confined Space permit required?

General Inspection of Jobsite

  • Excavations, adjacent areas, and protective systems inspected before start of work?

  • Surface obstacles removed or if not possible, supported e.g. posts, poles, trees

  • Loose rock or soil that could pose a hazard by falling or rolling into the excavation have been removed or made safe

  • Appropriate PPE is worn by all employees in and around the trench

  • Spoil, materials, and equipment set back minimum required distance from the edge of the excavation

  • Unattended excavations are adequately protected

  • All lifting and electrical equipment is certified and current

  • There is a system in place on site to prevent employees working under suspended loads

Means of Access and Egress

  • Precautions taken to protect employees from the accumulation of water

  • System in place to check water removal equipment at regular intervals

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

Hazardous Systems

  • Atmosphere has been tested and proven safe by a competent gas detector operator

  • System in place for continuous testing to ensure atmosphere remains safe

Support Systems

  • Material and / or equipment for support systems has been selected based on ground conditions, trench depth and expected loads

  • Materials and equipment used for protective systems inspected and in good condition

  • Materials and equipment not in good condition have been removed from service

  • Damaged materials and equipment used for protective systems inspected after repairs and before being placed back into service

  • Appropriate protective systems can be put in place without exposing employees to hazards of cave-ins, collapses, or threat of being stuck by materials or equipment

  • Excavations below the level of the base of the footing supported, approved by an Engineer

  • Excavations of material to a level of no greater than 600mm below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth

  • Shield system placed to prevent lateral movement

  • Employees are prohibited from remaining in shield system during vertical movement

  • System in place for moving and removal of protective structures meets manufacturers specifications / recommendations

Summary

  • Trench is safe to enter

  • Please insert photo of trench

  • Any other comments

  • Please insert comments

  • Signature

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