1415 MAPLE ST 2016-01-01 MF Import

EXCAVATIONlI'RENCHING SAFETY CHECKLIST �� Date(s) of work: CS� � — /�� Work order# Location of work: �GI��7 A��.�A�� -.��" Is a"Competent Person", as defined in WAC 296-155-650, in chazge of job?.......................... Yes �No � HasDial-A-Dig been called?...................................................................................................... Yes-�No � Dial-A-Dig numUer Date &Time Dial-A-Dig Done Are traffic control devices in place7........................................................................................... Yes � No-_� _ � Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wall?................................... Yes � No'� (If yes, consult supervisor or engineer for recommendations.) If trenchlexcavation is less than 4 feet deep aze sides stable7..................................................... Yes,� No � (If not, then trench/excavation must be shored.) If trench ic morc than 4 feet deep is shoring in use?....................................�:....�.. ;i................ Yes L No � �� J Is shoring rated for depth oftrench/excavation?........................�. ...�.:.......... ................. Yes [� No � Is tabulated data for the shoring on the job site?............................................................. Yes 0 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?..................................................... Yes�No � Is a ladDo s it extend03 feet abo efromof t ench�cavation?.::::.:::::::......: ...i;.... ........................ Yes � No � ry • p . . . .!.1+ ....�...................... Yes � No � Is it secured at the top?.........................................................�...1.:.................................. Yes � No � Has it been inspected for defects/problems today?......................................................... Yes � No ❑ Is there a means of communication with rescuers in the event of an accidendproblem?........... Yes �_No � 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'0_ (Such as from leaking gas mains, neazby industries, work over landfills, or other situations.) If yes, is a calibrated gas detector in use?........................................................r..;./..::.... Yes � No � If yes, is a means of retrieval available for workers in the trench/excavation?':.,1::...... Yes � No � Are all workers on site aware of safety requir^em_ents for workers in trenches/excavations?..... Yes,fl No � , � r Signature of Crew Leader: /� �J�u�-. �/,�% �? �� ` �� l Y-% � L Date: - , FO0.\15 OIf001CKL(LAINUl95)