1432 MAPLE ST 2016-01-01 MF Import

EXCAVATIONlI'RENCHING SAFETY CHECKLIST i Date(s) of work: � � .�.— 9S Work order# Location of work: /`�3� /'✓)F Q I� .1.�" Is a"Competent Person", as defined in WAC 296-155-650, in chazge of job?.......................... Yes�rlo � HasDial-A-Dig been called?...................................................................................................... Yes�No � Dial-A-Dig number Date &Time Dial-A-Dig Done Are tra�c control devices in place?........................................................................................... Yes�No � Is trench/evacuation on the toe of a hill, slope, or neaz a retaining�vall?................................... Yes � No� (If yes, consult supervisor or 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?........................ ... .. . Yes � No � Is shoring rated for depth of trench/excavation?.............. .. .. .. .... ............................... 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 botto�: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?......................... .. .�..�. .�.......................... Yes � No ❑ Is it secured at the top?......................................................��If•••••............................... 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�,. No � Are the open sides of the trench/excavation barricaded, or protected, to prevent falls?............. Yes^�No � I Is there is a possibility of hazaz•dous 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?............................................ .f.(L.�. . . Yes � No � If yes, is a means of retrieval available for workers in the trench/exc,�ati6n7.............. Yes [! No � Are all workers on site awaze of safety require ents for workers in uenches/excavations? ..... Yes � No � Signature of Craw Leader: Date: rortais:n000 re��c�nivuros>