808 HOYT AVE 2016-01-01 MF Import

Date(s) of work: Location of work: EXCAVATION/TRENCHING SAFETY CHECKLIST //; - �% 9 � Work order � 4� t/- ,. �- Is a"Competent Person", as defined in WAC 29b-155-650, in chazge of job?...... Has Dial-A-Dig been called% ......................... Dial-A-Dig number Date & Time Dial-A-Dig Are traffic control devices in place? ............... Is irench/evacuation on the toe of a hill, slope, oc neaz a retaining wall? (If yes, consult supervisor or engineer for recommendations.) � If trench/excavation is less than 4 feet deep aze sides stable? ........................... (If not, dien trench/excavation must be shored.) If trench is more than 4 feet deep is shoring in use? ............... �— Is shoring rated for depth of trench/excavation? .......................:..1....... Is tabulated data for the shoring on the job site? .................:................ Are spoil piles and other material stored at lease 2 feet from the edge of the trench/excavation? Yes �No � Yes [j No �— Yes �. No � .... Yes � No � Yes [� No � ............... Yes ❑ No � ..................... Yes � No Q ..................... Yes � No ❑ ........... Yes 0- No � ls water removed from the bottom of the trench/excavation? ..................................................... Yes 0 No � Is a ladder available for entry/exit from trench/excavation? ......................�I .... �....................... Yes � No � Does it extend 3 feet above top of trench? ....................................:.....T�..................... Yes � No � Is it secured at the to � ..................................... Yes ❑ No � p . ............................................................... Has it been inspected for defects/problems today? ......................................................... Yes � No � Is there a means of communication with rescuers in the event of an accidendproblem? Are the opzn sides of the trench/excavation barricaded, or protected, to prevent falls? Yes �- No � ........ Yes 0 No [] Is there is a possibility of hazazdous atmospheres in the trench/excavation? ............................. Yes � No Q (Such as from leaking gas mains, nearby industries, work over landfills, or other situations.) ... ... . . .. .. . ...... �.. Yes No If yes, is a calibrated gas detector in use? ................................ . . . . . . . . ��.. � ❑ ❑ If yes, is a means of retrieval available for workers in the trench/excavation? � ....:........ Yes � No ❑ Are all workers on site awaze of safety requir � ents for workers in trenches/excavations? / Signature of Crew Leader: �'U �1v��• �'� � ;'�"'��"' "� Date: ii:- - `'/— � >' ..... Yes 0. No ❑ wa.vs 0000icr:�0.aiuuias)