Information
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Job name / Job #
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Conducted on
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Prepared by:
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Location
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Personnel
Personal Protective Equipment
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Are all workers wearing class 2 safety apparel?
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Are all workers wearing hard hats?
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Is appropriate footwear being worn?
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Is eye protection being worn for chipping / grinding operations?
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Is ear protection being worn for work over 85dB?
Excavation
General Job Site Inspection
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Competent Person
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Soil Classification
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Excavation Depth
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Excavation Width
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Protective system required?
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What type of protection being used?
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Were excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work?
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Are all employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation?
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Are all spoils, materials and equipment set back at least 2 feet from the edge of excavation?
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Are barriers provided at all remotely located excavations, wells, pits, shafts, etc.?
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Has a warning system been established and utilized when mobile equipment is operating near the edge of the excavation?
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Are employees prohibited from going under suspended loads?
Utilities
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Are all utilities notified, located and is the OneCall ticket valid?
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Locate Ticket#
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Are underground installations protected, supported, or removed when excavation is open?
Means of access and egress
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Is lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth?
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Are all ladders used in excavations secured and extended three feet above the edge of the trench?
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Are employees protected from cave-ins when entering and exiting the excavation?
Wet Conditions
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Are precautions taken to protect employees from the accumulation of water?
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Is water removal equipment monitored by a competent person?
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Is surface water or runoff diverted or controlled to prevent accumulation in the excavation?
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Are inspections made after every rainstorm or other hazard-increasing occurrence?
Hazardous Atmosphere
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Is the atmosphere within the excavation tested where there is reasonable possibility of an oxygen deficiency, combustible or other harmful contaminant exposing employees to a hazard?
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Are precautions taken to protect employees from exposure to an atmosphere containing less than 19.5% oxygen and or to other hazardous atmospheres?
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Is ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas?
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Is testing conducted often to ensure that the atmosphere remains safe?
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Are employees trained to user personal protective and other rescue equipment?
Support Systems
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Are materials and/or equipment for support systems selected based on soil analysis, trench depth, and expected loads?
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Are materials and equipment used for protective systems inspected and in good condition?
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Materials and equipment that are not in good condition have been /will be removed from service.
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Have damaged materials and equipment used for protective systems been inspected by a registered professional engineer (RPE) after repairs and before being placed back into service.
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Have protective systems been installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment?
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Are members of support system securely fastened to prevent failure?
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Does the removal of support systems progress from the bottom and members are released slowly as to note any indication of possible failure?
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Does backfilling progress with removal of the support system?
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Excavation of material is no greater than two feet below the bottom of the support system
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Is the system is designed to support the loads calculated for the full depth of excavation (including the 2' below)
Traffic Control
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Is the approved TCP on site?
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Are warning signs properly posted?
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Are signs clean and in good condition?
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Are barrels / cones properly set?
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Are flaggers in the proper location and using stop / slow paddles
Trucks and Equipment
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Are strobes / flashers operational & in use?
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Are operators wearing seat belts?
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Are daily inspections complete?
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Are back up alarms operational?
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Are mirrors / backup cameras in good condition
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Are fire extinguishers on all trucks & equipment?
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Are cab(s) clean of trash & debris?
Misc Tools and Equipment
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Are hand tools in good condition? (No damaged handles/parts, proper for job)
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Are fuels stored in labeled safety cans?
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Are chemical containers labeled?
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Are MSDS / SDS available?
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Is lifting equipment adequate? Load rating tags in place & legible?
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Are extension cords in good condition
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Are GFCI's in use?
Misc.
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Foreman / Superintendent Signature