514 OLYMPIC BLVD 2016-01-01 MF Import

Date(s) of work: EXCAVATION/TRENCHING SAFETY CHECKLIST � — 3 ' I'�S Work order Location of work: S� Is a"Competent Person", as defined in WAC 296-155-650, in chazge of job? Has Dial-A-Dig been called?... Dial-A-Dig number Are traffic control devices in place? ................................. Date & Time Dial-A-Dig � ........... Yes �No � ............. Yes�No ❑ Yes � No � Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wall? .......................... ........ Yes 0 No� (If yes, consult supervisor or engincer for recommendations.) If trench/excavation is less than 4 feet deep aze sides stable? ..................................................... Yes �No ❑ (If not, then trench/excavation must be shored.) If hench is more than 4 feet deep is shoring in use? ........................... ........1.....� ..................... Yes ❑ No ❑ Is shoring rated for depth of trench/excavation? ................. ... .... ...... ..... ................... Yes � No ❑ Is tabulated data for the shoring on the job site? ............... .................1......................... 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? ....................................... Is a ladder available for entry/exit from trench/excavation? ................................... :i............ Does it extend 3 feet above top of trench? .............................................�••;`•�•• Is it secnred at the to � �•i�l•••••••••••••••• p .......................................................................... .... Has it been ins ected for defects/ roblems toda � " p p y . ......................................................... Is there a means of communication with rescuers in the event of an accidenUproblem?........... .� Are the open sides of the trench/excavation barricaded, or protected, to prevent falls? _� ' ■ Yes ❑ No ❑ Yes � No � Yes � No � Yes � No ❑ Yes,�}�No ❑ Yes�No ❑ Is there is a possibility of hazardous atmospheres in the trench/excavation? ............................. Yes [] No j�, (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 retrieval available for workers in the trench/excava�iol�?�.�...... Yes � No ❑ Are all workers on site awaze of, afety re ments for workers in trenches/excavations? ..... Yes � No ❑ (t�l, t�,�� C�'L- Date: �^3 —��ZJ Signature of Crew Leader. — ron.�is numicnuuidurvs>