Trenching & Excavation Checklist

• Name of checklist

  Trenching inspection checklist

  Excavation inspection checklist

• Document No.

• Conducted on

  Date

• Prepared by

  Select James Brown Lee Ratliff Richard Dickinson Hugh French Jason Corbin Scott Taylor Michael Wright Anthony Beverly Christopher Cole James Shifflett Chuck Ayers Joe Bailey Michael Dwyer Tom Chestnut Gary Berghan Clyde Eppard Mark A. Davis

  • James Brown
  • Lee Ratliff
  • Richard Dickinson
  • Hugh French
  • Jason Corbin
  • Scott Taylor
  • Michael Wright
  • Anthony Beverly
  • Christopher Cole
  • James Shifflett
  • Chuck Ayers
  • Joe Bailey
  • Michael Dwyer
  • Tom Chestnut
  • Gary Berghan
  • Clyde Eppard
  • Mark A. Davis
• Location of trench or excavation (Drop pin for GPS and street address):
  Address

MISS UTILITY

• Has the excavation site been mark by Miss Utility?

  Yes

  No

  N/A

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

  Media

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:

  Yes

  No

  N/A

• Please provide photo of competent person training card

  Media

• Are all on surface encumbrance removed or supported

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Daily prior to start of work

  As needed throughout the shift

  After every rainstorm or other occurrence that could increase the hazard

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are employees prohibited from going under suspended loads?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

UTILITIES

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

  Yes

  No

  N/A

• Are the exact locations clearly marked?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

ACCESS & EGRESS

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

WET CONDITIONS

• Are precautions taken to protect employees from water accumulation?

  Yes

  No

  N/A

• Is water removal equipment monitored by competent person ?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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).

  Media

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Photo of Controlled Access Zone (CAZ)

  Media

SOILS

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

  Yes

  No

  N/A

• Visual test

  Select Solid rock Type A Type B Type C

  • Solid rock
  • Type A
  • Type B
  • Type C

• Manual test

  Select Solid rock Type A Type B Type C

  • Solid rock
  • Type A
  • Type B
  • Type C

SUPPORT SYSTEMS

• Type of support system being used?

  Select Sloping Shoring Shielding Designed by Registered Professional Engineer

  • Sloping
  • Shoring
  • Shielding
  • Designed by Registered Professional Engineer

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are damaged materials and equipment immediately removed from service?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is a shield system installed to prevent lateral moment?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Signatures

• Persons working inside the trench or excavation:

Please sign to acknowledge

• Signature:

  Sign

• Foreman's Approval To Enter Trench or Excavation:

  Sign