Information

  • Name of checklist

  • Document No.

  • Conducted on

  • Prepared by

  • Location of trench or excavation (Drop pin for GPS and street address):

MISS UTILITY

  • Has the excavation site been mark by Miss Utility?

  • Please take photos of markings at and around the immediate area of the trench or excavation:

GENERAL INSPECTION

  • Has the "Competent Person" had specific training in, and is knowledgeable about soil analysis, use of protective systems, and the requirements of 29 CFR 1926 - Subpart P:

  • Please provide photo of competent person training card

  • Are all on surface encumbrance removed or supported

  • Are all employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation?

  • Does the "Competent Person" have the authority to remove workers from the excavation immediately?

  • Are excavations, adjacent areas, and protective systems inspected by a competent person:

  • Are spoiled, materials, and equipment set back at least 2 feet from the edge of your excavation

  • Are barriers provided at all remotely located excavations, wells, pits, shafts, etc.?

  • Are walkways and bridges over excavations 6 feet or more in depth and 30 inches or more in width equipped with standard guard rails and toe-boards?

  • Are warning vests or other highly visible clothing provided and worn by all employees exposed to vehicle traffic?

  • Are employees required to stand away from vehicles being loaded and unloaded?

  • Are warning systems established and used when mobile equipment is operating near the edge of an excavation?

  • Are employees prohibited from going under suspended loads?

  • Are employees prohibited from working on the face of slope or benched excavation above other employees?

UTILITIES

  • Are utilities companies contacted and/or utilities located as required by local, state, and federal law?

  • Are the exact locations clearly marked?

  • Are underground installations protected, supported, or removed when the excavation is open?

ACCESS & EGRESS

  • Are ladders or other means of access and egress in place and all trenches 4 feet or more in depth?

  • Are all employees within 25 feet of a means of access and egress?

  • Are the ladders that are used in the excavation secure and extended 3 feet above edge of the excavation?

  • Are all structural ramps used by employees designed by a competent person?

  • Are all structural ramps used for equipment designed by a Registered Professional Engineer?

  • Are all ramps constructed of materials of uniform thickness, cleated together, equipped with non-slip surfaces?

WET CONDITIONS

  • Are precautions taken to protect employees from water accumulation?

  • Is water removal equipment monitored by competent person ?

  • Is surface water or runoff diverted after every rainstorm or other hazard increasing occurrence?

HAZARDOUS ATMOSPHERES

  • Per company policy, the atmosphere within all excavations are tested when there is a possibility of an oxygen deficiency, oxygen enriched, combustible, toxic, or other harmful contaminant.

  • Gas Monitor Number:

  • Photo of monitor after the test. (Picture of screen or readout).

  • Oxygen Percentage

  • Retest and confirm safe limits with Safety Manager

  • Hydrogen Sulfide (PPM)

  • NOT SAFE TO ENTER

  • Carbon Dioxide (PPM)

  • NOT SAFE TO ENTER

  • Carbon Monoxide (PPM)

  • NOT SAFE TO ENTER

  • Ammonia (PPM)

  • NOT SAFE TO ENTER

  • LEL (Lower Explosive Level) Percentage

  • NOT SAFE TO ENTER

  • Are adequate precautions taken to protect employees from exposures to an atmosphere containing less then 19.5% oxygen and or other hazardous atmosphere?

  • Is verification provided to protect employees from an atmosphere containing flammable gases in excess of 10% of the lower explosive limit of the gas?

  • Is emergency equipment available when hazardous atmosphere could or do exist?

  • Are employees trained to use personal protective equipment and other rescue equipment?

  • Has the Controlled Access Zone (CAZ) been established?

  • Photo of Controlled Access Zone (CAZ)

SOILS

  • Has the competent person classified the soil using one manual test and one visual test, as specified by the standard?

  • Visual test

  • Manual test

SUPPORT SYSTEMS

  • Type of support system being used?

  • Are materials and/or equipment chosen based upon soil analysis, Trench depth and expected it loads?

  • Are materials and equipment that are used for protective systems inspected and in good condition?

  • Are damaged materials and equipment immediately removed from service?

  • Are damaged materials and equipment inspected by a registered professional engineer after repairs are made in before being placed back into service?

  • Are protective systems installed without exposing employees to hazards of cave-ins, collapses, or other threat of being struck by materials or equipment?

  • Are all members of support system securely fastened together prevent failure?

  • Are support systems provided to insure stability of adjacent structures, buildings, roadways, sidewalks, etc.?

  • Are excavation below the level of the base or footings supported, and approved by a Registered Professional Engineer?

  • Does back-filling progress with removal of the support system?

  • Is a shield system installed to prevent lateral moment?

  • Are employees prohibited from remaining in a shield system during vertical movement?

Signatures

  • Persons working inside the trench or excavation:

  • Please sign to acknowledge
  • Signature:

  • Foreman's Approval To Enter Trench or Excavation:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.