1418 MAPLE ST 2016-01-01 MF Import

EXCAVATIONlTRENCHING SAFETY CHECKLIST Date(s) of work: _�� - � -��) � Work order# Location of work: _ / `� 1`� ��.��f ��{ Is a"Competent Person", as defined in WAC 296-I55-650,in chazge of job?.......................... Yes�No � HasDial-A-Dig been called?......................................................................................................Yes��10 � Dial-A-Dig number Date & Time Dial-A-Dig Done Are traffic control devices in place?........................................................................................... Yes'��❑ Is trenchlevacuation on the toe of a hi(l, slope, or neaz a retaining wall?................................... Yes � No,� (If yes, consult supervisor or engineer for recommendations.) 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?.................................. . '/1,.................. Yes � No � . ....., .. � ;; Is shoring rated for depth of trench/excavation7.......................!. .. .:.. .,.. ..................... 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/excavation? Is water removed from the bottom of the trench/excavation?..................................................... Yes�No � Is a ladder available for entry/exit from trench/excavation?................... .' ,�!..................... Yes ❑ No � ........... Does it extend 3 feet above top of trench?...........................i!�..-/�.�................. Yes � No [i Isit 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 accidenUproblem?........... Yes'�' No � Are the open sides of the trench/excavation barricaded, or protected, to prevent falls?............. Yes�`No � Is there is a possibifity of hazazdous atmospheres in the trencl�/excavation?............................. Yes � No []_ (Such as from leaking gas mains, nearby industries, wurk over landfills, or other situations.) If yes, is a calibrated gas detector in use?.........................../. ...::�.f�� .'� . . Yes ❑ No � If yes, is a means of retrieval available for workers in the�frencti/ezcavation?.............. Yes ❑ No � Are all workers on site aware of safety requirements for workers in trenches/excavations?..... Yes � No � ----, r Signature of Crew Leader: ��l��Y��' i�/"r'.YJ7 �� Date: `•� � ~ `� �� , � . roa.�is unooicK�aniwurost �