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Date(s) of work: <br />Location of work: <br />EXCAVATION/TRENCHING SAFETY CHECKLIST <br />�N <br />Wc�rk order <br />Is a"Competent Person", as defined in WAC 296-155-(i50, in chazge of job? <br />Has Uial-A-Dig been called? <br />Dial-A-Dig number <br />Date & Time Dial-A-Dig <br />Are traffic control devices in place? ................... <br />Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wall? <br />(If yes, consult supervisor or engineer for recommendations.) <br />....... Yes �. No � <br />...... Yes � No � <br />...............Yes�NoO <br />If trench/excavation is less than �3 feet deep aze sides stable? ..................................................... <br />(If not, then trer.ch/excavation must be shored.) <br />If trench is more tt,an 4 feet deep is shoring in use? ..................................... .�. .. <br />Is shoring rated for depth of trench/excavation? ..........................�� <br />....................... <br />Is tabulated data for the shoring on the job site? ............................................................. <br />Yes � No'� <br />Yes � No � <br />�Yes � No � <br />Yes � No � <br />Yes � No � <br />Are spoil piles and other material stored at lease 2 feet from the edge of the ........................... Yes �No � <br />trenet✓excavation? <br />Is water :emoved from the bottom of the trench/excavation? ..................................................... Yes`�No � <br />Is a ladder available for entry/exit from trench/excavation? ....................................................... Yes � No � <br />Does it extend 3 feet above top of trench? ..........................���./,f j............................ Yes � No [� <br />Isit secured at the top? ....................................................... �........ �.. �............................. Yes � No � <br />Has it bcen inspected for defec�s/problems today? ......................................................... Yes � No � <br />Is there a means of communication with rescuers in the event of an accidendproblem? ..... <br />Are the open sides of the trench/excavation barricaded, or protected, to prevent falls? <br />.. Yes� No � <br />Yes j� No � <br />Is there is a possibility of hazazdous atmospheres in the trench/excavation? ............................. Yes � No'� <br />(Sucn as from leaking gas mains, r�eazby industries, work over landfills, or other situations.) <br />Ifyes, is a calibrated gas detector in use? ............................................................ �� Yes � No � <br />If yes, is a means of retrieval available for workers in tlie trench/excavation? .��....... Yes � No � <br />Are all workers on site aware of safety requi�,ements for workers in trenches/excavations? ..... Yes �No � <br />Signature of Crew Leader: '/!c' [ n( 4,t%rva(9✓ Date: `%� `�� � 9% <br />eoaau�.nnroi�r:�aniwu�ss) � <br />