7020 BEVERLY BLVD 2016-01-01 MF Import

Date(s) of work: Location of work: �XCAVATION/TF2�NCHING SAFETY CHECKLIST � ��– 9 � Work order �! /h � 35� � Is a"Competent Person", as defined in WAC 296-155-65Q, in chargc of job? .......................... Yes�, No � :Ias Dial-A-Dig been called? ...................................................................................................... Yes� No� Dial-A-Dig number ✓ Date & Time Dial-A-Dig Done ° Are traffic control devices in place? ........................................................... Yes� No � Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wa;l? ................................... Yes � No� (If yes, consult supervisor or engineer for recommendations.) If trench/excavation is less than 4 feet deep aze sides stable? .............. (If not, then trench/excavation must be shored.) If trench is more than 4 feet deep is shoring in use7........ ......................... Yes� No � ...................... Yes � No� Is shoring rated for depth of trench/exc�vation7 .................. .................................. Yes � No � Is tabulated data for the shoring on the job site? ............................................................. Yes � No � Are spoil piles and other material stored at lease 2 feet from the edge of the ........................... Yes j� No � trench/excavation? Is water removed from the bottom of the trench/excavation? ..................................................... Yes,� No � Is a ladder available for entry/exit from trench/excavation?...... Does it extend 3 feet above top of hench7 ............. Is it secured at the top? ...................... .................... Has it been inspected for defects/proi!ems today? �, ............................ ........._._ ..� ........... ................................... Yes � No � Yes � No � Yes � No � Yes � No � Is there a means of communication with rescuers in the event of an accident/problem?........... Yes� No � , Are the open sides of the trench/excavation bamcaded, or protected, to prevent falls? ............. Yes � No � Is there is a possibility of hazardous atmospheres in the trench/excavation7 ............................. Yes � No� (Such as from leaking gas mains, nearby industries, work over landfills, or other situations.) If yes, is a calibrated gas detector in use? ............................... ............................... Yes � No � If yes, is a means of retrie��al available for workers in the trenchlexcavation? ..--�... Yes � No ❑ Are all workers on site awaze of safety requirements for •��. r ers in trenches/excavations? ..... Yes�j No � Signature of Crew Leader: „ � •• .. %i ,�Z� — llate:_ � � � � %S .� roaa�s.noroicKu��au�vs� •