3701 ROCKEFELLER AVE 2018-01-02 MF Import

� Date(s) of work: Location of work: EXCAVATION�I'RENCHING SAFETY CHECKLIST 7� �� -� Workorder# ilL'-�I�-(�Jj 'C�"� �� Is a"Competent Person", as defiued in WAC 296-155-650, in chazge of job? .......................... Yes�0�10 � Has Dia]-A-Dig been called?........... ............................................................. Yes � No �, Dial-A-Dig number Date & Time Dial-A-Dig Done Are traffic control devices in place? ........................ �!�'/�:..................................1'es � No � ......................� ..... Is trench/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 tli 4 feet deep aze sides staUle? ..................................................... Yes� No � • (If not, then trencl�/exc.,,vation must be shored.) ` If trench is mpre tha�� 4 feet deep is shoring in use? .........................a.. ............................. Yes � No � � . Is shoring ratcd for depth of trench/excavation�. /. ....�� ............................ Yes No . ............ .� ❑ ❑ Is tabulated data for the shoring on thejob site? ........... ...........�................................... Yes � No 0 ' 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'j��No � Is a ladder available for entry/exit fr�om trench/excavation?....:.... j ............................... Yes � No � .. .. Does it extend 3 feet above top of vench? ....................,./ .. ..................................Yes� No� Isit secured at the top? .................................................................................................... Yes � No � Has it been inspected for defects/problems today? .........................................................1'es � No � Is there a means of communication with rescuers in the event of an accidendproblem?........... Yes�No � . •._, Ar: the opea 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.) Ifyes, is a calibrated gas detector in use? ........................................... �.. .... �.. '.. Yes � No � If yes, is a means of retrieval available for workers in the trench/exc tiofi? .`............ Yes [[ No � Are all worke:c on site aware c,i safety requirements for workers in trenchcs/excavations? ..... Yes�No � Signature of Crew Leader: /[i.x ' ^d7� ,��t/ Date: 7 —1 � - �I �, t" FD�J.6��BOpICRLfLA1dIlA5)