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Date(s) of work: <br />Location of work: <br />EXCAVATION/fRENCHING SAFETY CHECKLIST <br />. <br />. � z�' � Work order # 7{G / I�I F 7� C• 2 7`'� <br />Is a"Competent Person", as defined in WAC 296-155-650, in chazge of job? .......................... Yes �. No � <br />HasDial-A-Dig been called? ...................................................................................................... Yes � No :E( <br />Dial-A-Dig number Date & Time Dial-A-Dig Done <br />Are traffic control devices in place? .................................................... �/. <br />.. .... A .......................... Yes � No � <br />Is trench/evacuation on the toe of a hill, slope, or near a retaining wall? ................................... Yes � No� <br />(If yes, consult supervisor or engineer for recommendadons.) <br />If trench/excavation is less than 4 feet deep aze sides stable? ..................................................... Yes �� No � <br />(If not, then trench/excavation must be shored.) <br />If trench is more than 4 feet deep is shoring in use7 ........................./...✓..!4............................... Yes � No � <br />Is shoring rated for depth of trench/excavation? ................. ... .. . . Yes � No � <br />... . .. <br />Is tabulated data for the shoring on the job site? ............... ........ �............................... Yes � No � <br />Are spoil piles and other material stored at lease 2 feet from the edge of the ......... <br />trench/excavation? <br />Is water removed from the bottom c f the trench/excavation? ......................................... <br />.... Yes �No � <br />Yes � No � <br />Is a ladder available for entry/exit from trench/excavation? ..........................,t.i�� .f.a................ Yes [� No � <br />Does it eactend 3 feet above top of trench? .......................... ... . Yes � No ❑ <br />Is it secured at the top? ............................................ ..... .. . T . . .. .... . . Yes � No � <br />... <br />.... ... . .... . .. . .............. . <br />Has it been inspected for defects/problems today? ......................................................... Yes � No � <br />Is there a means of communication with rescuers in the event of an accidendproblem?........... Yes'� No � <br />Are the open sides of the trench/excavation barricaded, or protected, to prevent falls? ............. Yes„�_No � <br />Is there is a possibility of hazardous atmospheres in the trench/excavation7 ............................. Yes � No� <br />(Such as from leaking gas mains, neazby industries, work over landfills, or other situations.) <br />If yes, is a calibrated gas detector in use? ......................................� .l.� ..... Yes � No � <br />If yes, is a means of retrieval available for workers in the trench%�cadation? .............. Yes � No � <br />Are all workers on site awaze of safety requirements for workers in uenches/excavations? ..... Yes �No 0 <br />Signature of Crew Leader: _i[t ��hti':.• 2,•7�1/v1171/ Date: 7� z �-�� <br />i � <br />