1416 MAPLE ST 2016-01-01 MF Import

EXCAVATION/TRENCHING SAFETY CHECKLIST Date(s) of work: 4 •� �'- `I �/ — Work order# Location of work: /`'� �� I n ��E'� - ��" Is a"Competent Person", as defined in WAC 296-155-650,in chazge of job?.......................... Yes�No � HasDial-A-Dig been called?...................................................................................................... Yesr�No � Dial-A-Dig number Date&Time Dial-A-Dig Done Are traffic control devices in place?...........................................................................................Yes ❑ No-[-�- Is trench/evacuation on the toe of a hill, slope,or near a retaining wall?................................... Yes � No j� (If yes, consult supervisor or engineer for reconunendations.) If trench/excavation is less than 4 feet deep aze sides stable7..................................................... Yes'�No ❑ (If not, then trench/excavation must be shored.) If trench is more than 4 feet deep is shoring in use?............................. .....�� ......................... Yes ❑ No [J , ��i , Is shoring rated for depth of trench/excavation?......................!!.i.:.✓..............................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„�No ❑ trench/excavation7 Is water removed from the bottom of the trench/excavation7..................................................... Yes'�No ❑ Is a ladder available for entry/exit from trench/excavation?..................... ................................. Yes � No ❑ Does it extend 3 feet above top of trench?................................. ..:�/.:�................... Yes ❑ No ❑ Is it secured at the top?........................................................... :..�:....�..�.......:.................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 accident/problem?........... Yes{r�-I�Io � Are the open sides of the trenclJexcavation barricaded, or protected, to prevent falls?............. Yes.O�No ❑ Is there is a possibility of hazarduus atmospheres in the trench/excavation?............................. Yes ❑ No�_ (Such as from leaking gas mains, neazby industries, �vork over landfills, or other situations.) If yes, is a calibrated gas detector in use?............................................� .r•`y............. Yes ❑ No ❑ If yes, is a means of retrieval available for workers in the trench/exdaLatibn?.............. Yes ❑ No � Are all workers on site aware of safety requirements for workers in Venches/excavations?..... Yes � No� �* � - Signature of Crew Leader: / <<'n `�•' �/' � �� Date: � `� � - 7 -' roan�s�nnooicn�t�a�wi�ros�