1907 LOMBARD AVE 2016-01-01 MF Import

EXCAVATION/TRENCHING SAF�TY CFIECKLIST c ,- Date(s) of work: 7 - I ( - % �;� Work ocder# i l �.��- � � ` I -� �-� �� ' � �-� � ' Location of:uork: 1 'i(� 7 / � i � � � �i-� r r� '' Is a"Competent Person",as defined in WAC 296-155-650, in charge of job?.......................... Yes �No � HasDial-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 wall?................................... Yes [J No �, (If yes, consult supervisor or engineer for recommendations.) If trench/excavation is less than 4 feet deep aze sides stable?.........................�:-.:.C�................. Yes�No � ' j (If not, then trench/excavation must be shored.) � If trench is more than 4 feet deep is shoring in use?...........................!..i....�.�........................... Yes � No � Is shoring rated for depth of trench/excavation?...................../ ; Yes � No � Is tabulated data for the shoring on the job site?....................l..�::...��........................ Yes � No ❑ Are spoil piles and other material stored at lease 2 feet from the edge of the........................... Yes�,No � trench/excavation? Is water removed from the bottom of the trench/excavation?..................................................... Yes�] No ['j Is a ladder available for entiy/exit from Vench/excavation?................:f':.:.f:�.......................... Yes � No ❑ . o .............. Yes No Does ii extend 3 feet above top of trench..............................�......;.. ............... ❑ � Is it secured at the to � �� Yes � No � p.................................................. ... ....:..... ..... :............................ , �- Has it been inspected for defects/problems today?....:................ ................................... Yes � No 0 is there a means of communication with rescuers in the event of an accidenUpr�blem?........... Yes'�No � Are the open sides of the trench/excavation barricaded, or protect:d, b prevent falls'?............. Yes�,No � Is there is a possibility of hazardous atmospheres in the trenc�/excavation?............................. Yes (] No��_ (Sucli as from leaking gas mains, nearby industries, work over landfills, or other situations.) • ' ..... " ............... Yes No If yes, is a calibrated gas detector m use?................... � �{ .; . �/ 1• ••• • • • ❑ ❑ If yes, is a means of retrieval available for workers in tlie'trenctS/ex�avation?.............. Yes 0 No � Are all workers on site aware of safety requirements for workers in crenches/excavations? ..... Yes[x]' No � � ,�� , �..� , , -, ��`.' � n�-�,'!�)� Date: 7 �- I I ��l � Signature of Crew Leader: � � � • eon.+a�.nnooi eti�(�n+wi vvsi