Information

  • Job name / Job #

  • Conducted on

  • Prepared by:

  • Location
  • Personnel

Personal Protective Equipment

  • Are all workers wearing class 2 safety apparel?

  • Are all workers wearing hard hats?

  • Is appropriate footwear being worn?

  • Is eye protection being worn for chipping / grinding operations?

  • Is ear protection being worn for work over 85dB?

Excavation

General Job Site Inspection

  • Competent Person

  • Soil Classification

  • Excavation Depth

  • Excavation Width

  • Protective system required?

  • What type of protection being used?

  • Were excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work?

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

  • Are all spoils, materials and equipment set back at least 2 feet from the edge of excavation?

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

  • Has a warning system been established and utilized when mobile equipment is operating near the edge of the excavation?

  • Are employees prohibited from going under suspended loads?

Utilities

  • Are all utilities notified, located and is the OneCall ticket valid?

  • Locate Ticket#

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

Means of access and egress

  • Is lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth?

  • Are all ladders used in excavations secured and extended three feet above the edge of the trench?

  • Are employees protected from cave-ins when entering and exiting the excavation?

Wet Conditions

  • Are precautions taken to protect employees from the accumulation of water?

  • Is water removal equipment monitored by a competent person?

  • Is surface water or runoff diverted or controlled to prevent accumulation in the excavation?

  • Are inspections made after every rainstorm or other hazard-increasing occurrence?

Hazardous Atmosphere

  • 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?

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

  • 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?

  • Is testing conducted often to ensure that the atmosphere remains safe?

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

Support Systems

  • Are materials and/or equipment for support systems selected based on soil analysis, trench depth, and expected loads?

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

  • Materials and equipment that are not in good condition have been /will be removed from service.

  • 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.

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

  • Are members of support system securely fastened to prevent failure?

  • Does the removal of support systems progress from the bottom and members are released slowly as to note any indication of possible failure?

  • Does backfilling progress with removal of the support system?

  • Excavation of material is no greater than two feet below the bottom of the support system

  • Is the system is designed to support the loads calculated for the full depth of excavation (including the 2' below)

Traffic Control

  • Is the approved TCP on site?

  • Are warning signs properly posted?

  • Are signs clean and in good condition?

  • Are barrels / cones properly set?

  • Are flaggers in the proper location and using stop / slow paddles

Trucks and Equipment

  • Are strobes / flashers operational & in use?

  • Are operators wearing seat belts?

  • Are daily inspections complete?

  • Are back up alarms operational?

  • Are mirrors / backup cameras in good condition

  • Are fire extinguishers on all trucks & equipment?

  • Are cab(s) clean of trash & debris?

Misc Tools and Equipment

  • Are hand tools in good condition? (No damaged handles/parts, proper for job)

  • Are fuels stored in labeled safety cans?

  • Are chemical containers labeled?

  • Are MSDS / SDS available?

  • Is lifting equipment adequate? Load rating tags in place & legible?

  • Are extension cords in good condition

  • Are GFCI's in use?

Misc.

  • Foreman / Superintendent Signature

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.