1421 MAPLE ST 2018-01-02 MF Import

EXCAVATION/TRENCHING SAFETY CHECKLIST �' •- � � `'j Work order# Date(s) of work: � � , Location of work: �Y 2 ' /t'l'�� `E� �'�- Is a"Competent Person",as defined in WAC 296-155-650,in chazge of job?..........................Yes�No � Has Dial-A-Dig been called?......................................................................... .............................Yes,�No � Dial-A-Dig number Date &Time Dial-A-Dig Done Are tr�c control devices in place?................................................................. ..........................Yes•B'SIo ❑ Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wall?................................... Yes ❑ No, t� (If yes, consult supervisor�r engineer for recommendations.) If trench/excavation is less than 4 feet deep aze sides stable?.....................................................Yes,�No ❑ (If not,then trench/excavation must be shored.) If trench is more than 4 feet deep is shoring in use?.... ................. ....'��.••••••••••••••••••••••••••Z'es � No � .......................... Yes � No ❑ , , Is shoring rated for depth of trench/excavation?............�... .....:.........: 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 0 trench/excavation? Is water removed from the bottom of the trench/excavation7.....................................................Yes �- No ❑ Is a ladder available for entry/exit from trench/excavation?.................. .... ... .......................... Yes ❑ No ❑ , ! .�......................... Yes No Does it extend 3 feet above top of uench?...........................y •.�; •• •� yes❑ No � Is it secured at the to � . .............................................. ❑ p.............................. . Yes No Has it been inspected for defects/problems today?......................................................... � � Is there a means of communication with rescuers in the event of an accident/problem?........... Yes 0_No ❑ Are the open sides of the trench/excavation barricaded, or protected,to prevent falls?............. Yes�Q_ 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.) If yes, is a calibrated gas detector in use?....................... .�:•••••�•�• ••••••••••••••••••••••••��••• Yes ❑ No ❑ If yes, is a means of retrieval available for workers in the tredchl�xcavation? .............. Yes ❑ No ❑ Are all workers on site aware of safety requirements for workers in trenches/excavations?..... Yes �'_ No ❑ Signature of Crew Leader: , /� jC<<y��'!'OL Date: rak.�fs n000ic�:�0.mdui�sl