Title Page
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Date Conducted
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Conducted By
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Customer Name
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Job Name
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Location
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Duration of Work
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Has a 'Permit to Dig' been completed?
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Date & time 'Permit to Dig' completed
Trench / Excavation Inspection
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Has the need for a Trench Protection system been considered?
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Please give details
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Is there trench support available / in place onsite? (shoring, shielding, sloping, benching)
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Has a ground type / condition assessment been carried out?
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Who completed this assessment?
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Is there a way to enter / exit the trench safely? e.g. lader every 6m
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Has the site Foreman approved the trench for entry?
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Is there protection of open trenches? e.g. plates, fencing etc.
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If required, is de-watering equipment available?
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Is a Confined Space permit required?
General Inspection of Jobsite
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Excavations, adjacent areas, and protective systems inspected before start of work?
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Surface obstacles removed or if not possible, supported e.g. posts, poles, trees
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Loose rock or soil that could pose a hazard by falling or rolling into the excavation have been removed or made safe
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Appropriate PPE is worn by all employees in and around the trench
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Spoil, materials, and equipment set back minimum required distance from the edge of the excavation
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Unattended excavations are adequately protected
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All lifting and electrical equipment is certified and current
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There is a system in place on site to prevent employees working under suspended loads
Means of Access and Egress
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Precautions taken to protect employees from the accumulation of water
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System in place to check water removal equipment at regular intervals
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Surface water / runoff diverted or controlled to prevent accumulation in the trench
Hazardous Systems
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Atmosphere has been tested and proven safe by a competent gas detector operator
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System in place for continuous testing to ensure atmosphere remains safe
Support Systems
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Material and / or equipment for support systems has been selected based on ground conditions, trench depth and expected loads
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Materials and equipment used for protective systems inspected and in good condition
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Materials and equipment not in good condition have been removed from service
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Damaged materials and equipment used for protective systems inspected after repairs and before being placed back into service
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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
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Excavations below the level of the base of the footing supported, approved by an Engineer
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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
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Shield system placed to prevent lateral movement
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Employees are prohibited from remaining in shield system during vertical movement
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System in place for moving and removal of protective structures meets manufacturers specifications / recommendations
Summary
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Trench is safe to enter
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Please insert photo of trench
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Any other comments
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Please insert comments
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Signature