1422 MAPLE ST 2016-01-01 MF Import

EXCAVATION/TRENCHING SAFETY CHECKLIST Date(s) of work: > — � ' %� Work order!k Locationofwork: � �� -22 .�r//�n''F ��+ Is a"Competent Person", as defined in WAC 296-155-650, in chazge of jbb?.......................... Yes �No ❑ HasDial-A-Dig been called?...................................................................................................... Yes QNo � Dial-A-Dig number Date &Time Dial-A-Dig Done Are traffic control devices in place?........................................................................................... Yes 0.No � Is trenct�/evacuation on the toe of a hill, 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 stable?..................................................... Yes Q�No � (If not,then trench/excavation must be shored.) ' If trench is more than 4 feet deep is shoring in use?............................................:.....�................ Yes � No 0 } ' / ' Is shoring rated for depth of trench/excavation?........................:�/�....../..�I�,............... Yes � No � Is tabulated data for the shoring on the job site?......................:.t.�:.......,�.....:............... Yes � No ❑ j Are spoil piles and other material stored at lease 2 feet from the edge of the........................... Yes�_No � trench/excavation? .'s water removed from the bottom of the trench/excavation?..................................................... Yes'�]�Io � Is a ladder available for entry/exit from trench/excavation?..................... ........i::�............... Yes � No � ..... " Does it extend 3 feet above top of trench?..............................:�1.�.....r.:�...................... Yes � No � Is it secured at the to � �..........:.....�:................... Yes � No � p.............................................................:.. Has it Ueen 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 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 me ns tof ret ieval ava'ilable for workers in the trencl�/excava � � """ 1'es � No ❑ � .... Y tio�..'........... Yes � No � Are all workers on site aware of safety requirem�ts for workers in irenches/excavations?..... Yes � No � , ,•, �— �.: ' '"'7 ;�':C(� � ) Signature of CrewLeader: %/-(��`1 � '' '/ � ��i Date: � � ; �— Po0.NS�.OPOOICKLIL��d�1/95)