Title Page

  • Client / Site

  • Job #

  • Project Name

  • Project Location
  • Conducted on

  • Prepared by

Excavation Information

  • Excavation project description

  • Purpose of Trenching

  • Enter other purpose

  • Excavation Depth

  • Excavation Width

  • Take photo of the excavation area

  • Excavation tools and machines used

  • Has all heavy equipment undergone safety checks?

  • Approximate Temperature

  • Weather

  • Soil Type

  • Protective System

  • Enter other protective system

Jobsite Inspection

  • Competent person has the authority to remove employees from the excavation immediately.

  • Excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work.

  • Surface encumbrances removed or supported.

  • REFERENCE: No encrumbrances like utilities, foundations, streams, water tables, transformer vaults, walkways, bridges, roads, and geologic anomalies present
    [This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

    trench.jpg
  • Spoils, materials, and equipment set back at least two feet from the edge of the excavation.

  • Barriers provided at all remotely located excavations, wells, pits, shafts, etc.

  • Walkways and bridges over excavations four feet or more in depth are equipped with standard guardrails and toeboards.

  • Warning system established and utilized when mobile equipment is operating near the edge of the excavation.

  • Employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation.

  • Employees required to stand away from vehicles being loaded or unloaded.

  • Employees prohibited from going under suspended loads.

  • Employees prohibited from working on the faces of slopes or benched excavations above other employees.

  • Hard hats worn by all employees.

  • Warning vests or other highly visible clothing provided and worn by all employees exposed to public vehicular traffic.

Utilities

  • Utility companies contacted and/or utilities located.

  • Exact location of utilities marked.

  • Underground installations protected, supported, or removed when excavation is open.

Entry and Exit

  • Lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth.

  • Ladders used in excavations secured and extended three feet above the edge of the trench.

  • Structural ramps used by employees designed by a competent person.

  • Structural ramps used for equipment designed by a registered professional engineer (RPE)

  • Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with no-slip surface.

  • Employees protected from cave-ins when entering or exiting the excavation.

Wet Conditions

  • Precautions take to protect employees from the accumulation of water.

  • Water removal equipment monitored by a competent person.

  • Surface water or runoff diverted or controlled to prevent accumulation in the excavation.

  • Inspections made after every rainstorm or other hazard-increasing occurrence.

Hazardous Atmosphere

  • Atmosphere within the excavation tested where there is a reasonable possibility of an oxygen deficiency, combustible or other harmful contaminant exposing employees to a hazard.

  • Adequate precautions taken to protect employees from exposure to an atmosphere containing less than 19.5% oxygen and/or to other hazardous atmospheres

  • Ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas.

  • Testing conducted often to ensure that the atmosphere remains safe.

  • Emergency equipment, such as breathing apparatus, safety harness and lifeline, and/or basket stretcher readily available where hazardous atmospheres could or do exist.

  • Employees trained to use personal protective and other rescue equipment.

  • Safety harness and lifeline used and individually attended when entering bell bottom or other deep confined excavations

Support Systems

  • Materials and/or equipment for support systems selected based on soil analysis, 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 by a registered professional engineer (RPE) after repairs and before being placed back into service.

  • Protective systems installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment.

  • Members of support system securely fastened to prevent failure.

  • Support systems provided in ensure stability of adjacent structures, buildings, roadways, sidewalks, walls, etc.

  • Excavations below the level of the base or footing supported, approved by an RPE.

  • Removal of support systems progresses from the bottom and members are released lowly as to note any indication of possible failure.

  • Backfilling progresses with removal of support system.

  • Excavation of material to a level no greater than two feet 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.

Recommendations

  • Enter recommendations here

Completion

  • Full Name and Signature of Competent Person

  • Full Name and Signature of Inspector

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