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�a.: _ _ _
<br /> EXCAVATION/I'RENCHING SAFETY CHECKI,IST
<br /> Date(s) ofwork: � r 1 — ��-�
<br /> � Work order;�
<br /> Location of work: 1`/l C) ��l;:i�,�e ��i-
<br /> Is a"Competent Person",as defined in WAC 296-155-650, in chazge of job?......................
<br /> .... Yes,� No �
<br /> HasDial-A-Dig been called?...................................................................................................... Yes,�No �
<br /> Dial-A-Dig number __ Date & Time Dial-A-Dig Done
<br /> Are traffic conhol devices in place?..........................................................................................
<br /> . Yes � No��
<br /> Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wa11?,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, YeS � No�
<br /> (If yes, consnit suF�rvisor or engineer for reconunendations.)
<br /> If trench/excavation is less than 4 feet deep are sides stable?..................................................... Yes z�No �
<br /> (If not, then trench/excavation must be shored.)
<br /> If trench is more than 4 feet deep is shoriug in use?..................................
<br /> ........ ........................ Yes � No �
<br /> / ,
<br /> Is shoring rated for depth of trench/excavation?......................:.1..�.: �
<br /> Is tabulated data for the shorin on the 'ob site?........................ � ' Yes ❑ No �
<br /> � � � J.. ................. ........ � ❑
<br /> .. .................................. Yes No
<br /> Are spoil piles and other material stored at lease 2 feet from the edge ofthe........................... Yes�No r]
<br /> trench/excavation?
<br /> Is water removed from the bottom of the trench/excavation?..................................................... Yes.�\No �
<br /> Is a ladder available for entry/exit from trench/excavation?............. �
<br /> ... ...r...... ........................... Yes� No�
<br /> Does it�xtend 3 feet above top of trench?..................... � ,:� �/�
<br /> Is it secured at the top?.................. .. . .. .... . . .. . .. ............................ Yes � No �
<br /> Has it been inspected for defects/problems today?,..,,,..�„ ��� YeS ❑ No �
<br /> ........
<br /> ............................................ Yes � No �
<br /> Is there a means of communication with rescuers in the r.vent of an accident/problem?........... Yes�No �
<br /> Are the open sides of the trench/excavation barricaded, or protected, to prevent falls?............. Yes� No � I
<br /> Is there is a possibility of hazardous atmospheres in the trench/excavation?.................
<br /> (Such as from leakin ••••••�••••• Yes � No'0,
<br /> g gas mains, nearby industries, work over landfills, or other situations.)
<br /> Ifyes, is a calibrated gas detector in use?...................
<br /> If yes, is a means of retrieval available for workers in the trencl�/exca atio��.............. Yes � No 0
<br /> Are all workers on site awaze of safety requiremepts for�vorkers in trenches/excavations?..... Yes �] No �
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<br /> Signature of Crew Leader: / ;/citi/ti . ,j/��`J� y� .i��7�. � �.�
<br /> l Date: ; `/ ` / .
<br /> FOR.US BBODICKULMNUNSJ
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