1411 MAPLE ST 2016-01-01 MF Import

EXCAVATION/fRENCHING SAFETY CHECKLIST ' X�,, .a,< Date(s) of work: � — � Work order�=' Location of work: ;`f r, _/ti'l.�r� �•F. S'r Is a"Competent Person",as defined in WAC 296-I55-650,in cliazge of job?..........................Yes�No ❑ HasDial-A-Dig been called?......................................................................................................Ye� No ❑ Dial-A-Dig number Date&Time Dial-A-Dig Done Are traffic control devices in place?........................................................................................... Yes❑ No'� Is Vench/evacuation on the toe of a hill, slope, o�neaz a retaining wall?...................................Yes ❑ No`� (If yes, consult supervisor or engineer for reconunendations.) If trenclv'excavation is less than 4 feet deep aze sides stable?.....................................................Yes �No ❑ (If not.then trench/excavation must be shored.) If trench is more th::n 4 feet dee is shorin in nse?...................... ...L.... • Yes � No� P B �f. � ��.............................. Is shoring rated for depth of trench/excavation?...........1..!. .........�............................... Yes� No � Is tabulated data for the shoring on the job site?............................................................. Yes ❑ No❑ Are spoil piles and other material stored at lease 2 feet from the edge of the........................... Yes�Io� ' trench/excavation? Is water removed from the bottom of the trench/excavat:on?............... ..................................... Yes;�No ❑ ...�.� �'� Is a ladder available for enuy/exit from:rench/excavation?............... .............................. Yes � No � i,�' ; ' . /� ' ....................................Yes No Does �t extend 3 feet above top of trench?..............::....... ..... .. 0 ❑ Is it secured at the to � �'� ....................................................... Yes ❑ No ❑ Has it been ins ected for defects/ roblems toda � Yes � No G p p y. ......................................................... Is there a means of communication with rescuers in the event of an accident/problem?........... Yes'D,Nc ❑ Are the open sides of the trench/excavation barricaded, or protected, to prevent falls?............. Yes•[]_ No � Is there is a possibility of hazardous atmospheres in the trench/excavation?............................. Yes ❑ No �_ (Such as from leaking gas mains, neazby industries, work over landfills, or other situations.) • ' .... ................... Yes No If yes, is a calibrated gas detector m use?............... .................�..... .� ❑ ❑ If yes, is a means of retrieval available for workers in the treacN/e�ce vation?.............. Yes ❑ No ❑ Are all workers on site awaze of safety requi ements for workers in trenches/excavations? ..... Yes � No � Signature of Crew Leader: % I�4 t' ' �`'�'?/ '1��?` Date: �� � F00.V5 UOOOICKL(LAIGU�93)