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���� <br /> EXCAVATIONlTRENCHING WORKSHEET <br /> This form must be campleted for any excavation over 36" deep <br /> Trench Location <br /> Work Order # <br /> Date & Time <br /> Finai Trench Dimensions De th: Width: Len th: <br /> Excavations over 48" dee re uire a roved shorin or 1:1.5 s(o in <br /> Trenches are not confined spaces; however, atmosphe�ic testing must be performed continuously if there is: <br /> 1. titachinery running that could contaminate the trench with carbon monoxide(CO) <br /> 2. Underground storage tanks or pipelines that may have leaked into the surrounding soil <br /> 3. Known landfill or dump site that could migrate flammahle or noxious vapors into the trench <br /> 4. An condition that could contan� ie the atmos here in the area <br /> TRENCH CHECKLIST <br /> YES Pl0 N/A <br /> Have underground utilities been located? <br /> Are sides of excavation stable? <br /> Are proper trafiic controi devices in use? List: <br /> Are all spoiis,materials and equipment more than 2 teet from the excavation edges? <br /> Is shoring or sloping required? <br /> Is there standing or weeping water in the trench? <br /> Is a means o(communication with emergency responders provided? List: <br /> Radio Dispatch•Phone 311•City Phone 9•911 <br /> �s shoring rated for excavation? Tahulated data must te kept on site. <br /> Is a ladder or ramp avaiiable out of the trench every 50 feet? <br /> Is there a possibility ot hazardous atmosphere? <br /> Com etent Person <br /> Si nature <br /> Return Competed Permif to Safety wifhln 2 �Vorking Days <br /> � <br />