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EXCAVATION/TRENCHING WORKSHEET <br /> Com lete this for all excavations over 36" dee <br /> Excavations 48 inches or more dee re �ire a roved shorin or 1:1.5 slo in <br /> An excavation ma re uire shorin or slo in at an de th if there is a colla se hazard <br /> Trench Location <br /> Work Order # <br /> Date & Time <br /> Final Trench Dimensions De th: Width: Len th; <br /> Trenches are not confined spaces; however,atmospheric testing must be pertormed continuously if there is: <br /> ?. Machinery running that could contan�,inate the trench with carbon monoxide(CO) <br /> 2. Underground storage tanks or pipelines that may have leaked into the surrounding soil <br /> 3. Known landtill or dump site that could migrate Ilammable or noxious vapors into the trench <br /> 4. Any condition that could contaminate the atmosphere in the area <br /> TRENCH CHECKLIST <br /> YES NO N/A <br /> Have underground utilities been located? <br /> Are sides ol excavalion stabla? <br /> Are proper tralfic conlrol devices in use? List: <br /> Are all spoils,malerials and equipment more than 2 leet from the excavation edges? <br /> Is shoring or sloping required? <br /> Is there standing or weeping water in the trench? — <br /> Is a means of communication wilh emergency responders provided? Lisl: �` <br /> Radio Dispatch- Phone 911-City Phone 9-911 <br /> Is shoring rated lor excavation? Tabulated data must be kept on site. <br /> Is a ladder or ramp available out ol the trench every 50 teet? <br /> Is Ihere a possibilily ot hazardous atmosphere? <br /> Competent Person <br /> ( Signature � <br /> Return Completed Permit to Safety within 2 Working Days <br /> S:\hlPdunro\Excavatian\Excavalion checklist.doc �y�01 <br /> i <br /> /� <br />