Trenching/Excavation Inspection Checklist

• Conducted on

  Date

• Project Name:

• Job Number:

• JULIE #:

• Weather:

  Select Clear Cloudy Rainy Snowy Calm Windy

  • Clear
  • Cloudy
  • Rainy
  • Snowy
  • Calm
  • Windy

• Temperature:

• Job Site Conditions:

  Select Open Congested Restricted Wet/Muddy Windy

  • Open
  • Congested
  • Restricted
  • Wet/Muddy
  • Windy

Date & Time of Inspection:

• Date/Time:

  Date

PPE:

• Hard Hats

• Safety Glasses

• High Visible Clothing

• Gloves if required

Excavation:

• EXCAVATION LENGTH IN FEET

• EXCAVATION DEPTH IN FEET

• EXCAVATION WIDTH IN FEET

• TYPE OF PROTECTIVE SYSTEM:

  Select Sloping Benching Shoring Trench Box

  • Sloping
  • Benching
  • Shoring
  • Trench Box

Soil test

• Visual Analysis of Soil:

  Soil remains in clumps-Cohesive

  Soil breaks up easily-Granular

• PENETROMETER READING

• SOIL TYPE:

  Stable Rock

  Soil Type B 0.5-1.5 tons/ft2

  Soil Type C 0.5 tons/ft2 or less

Excavation Checklist 4' ft - 20' ft depth

• Excavations and protective systems inspected by Competent Person daily, before start of work?

  Yes

  No

  N/A

• Competent Person has authority to remove workers from excavation immediately?

  Yes

  No

  N/A

• Traffic Control in place if required?

  Yes

  No

  N/A

• Have site specific hazards been noted?

  Yes

  No

  N/A

• Surface encumbrances supported or removed?

  Yes

  No

  N/A

• Employees protected from loose rock or soil?

  Yes

  No

  N/A

• Spoils, materials, and equipment set back a minimum of 2 ft from edge of excavation?

  Yes

  No

  N/A

• Barriers provided at all remote excavations, wells, pits, shafts, etc..?

  Yes

  No

  N/A

• Walkways and bridges over excavations 6' ft or more in depth equipped with guard rails?

  Yes

  No

  N/A

• Employees prohibited from walking under suspended loads?

  Yes

  No

  N/A

• Ladders provided every 25 ft laterally from each worker in excavations over 4' ft in depth?

  Yes

  No

  N/A

• Top of ladders 3' ft or more above grade?

  Yes

  No

  N/A

• Protective system or benching in place in an excavation over 5' ft in depth?

  Yes

  No

  N/A

• Is trench box labelled and in proper condition?

  Yes

  No

  N/A

• Trucks & delivery drivers advised to stay back 20' ft from excavation?

  Yes

  No

  N/A

• Excavations protected if required to be left open overnight?

  Yes

  No

  N/A

Utilities

• Utility companies contacted and/or located?

  Yes

  No

  N/A

• Utilities marked?

  Yes

  No

  N/A

• Are utilities supported?

  Yes

  No

  N/A

Wet Conditions

• Cautions taken to protect employees from accumulation of water?

  Yes

  No

  N/A

• Water removal equipment monitored?

  Yes

  No

  N/A

• Surface water controlled or diverted?

  Yes

  No

  N/A

• Inspection made after each rainstorm?

  Yes

  No

  N/A

Hazardous Atmosphere

• Atmosphere tested if greater than 4' ft?

  Yes

  No

  N/A

• Oxygen content between 19.5% and 21%?

  Yes

  No

  N/A

• Testing conducted to ensure that atmosphere remains safe?

  Yes

  No

  N/A

• Emergency equipment readily available where a hazardous atmosphere could or does exist?

  Yes

  No

  N/A

• Employees trained in the use of personal protective an emergency response equipment?

  Yes

  No

  N/A

• Safety harness and life line individually attended when employees enter permit required confined space?

  Yes

  No

  N/A

• IF YOU HAVE ANSWERED "NO" TO ANY OF THE ABOVE QUESTIONS OR ARE UNSURE OF ANY HOW TO ANSWER, STOP WORK IMMEDIATELY AND CALL THE A&R SAFETY DEPARTMENT FOR ADVISEMENT!

• Signature of Competent Person

  Sign