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�'F . i S .bh R"... . �� Iw�'y�I.�f(f{i"�•�i.g'2"A ♦ I�+Y.. _ ` ....ti . . . __. _ �t� 1P".r ��� . ��l <br /> �,ir;��.� ..��:�4k'i' :}'.gr'�^1 F.T' uU.� . �`.K��*4�•t�' i� rfi;v{�s�t ��S .,r \ � f�F��t ��� tF>lf�e r�1'�':..�..` .: .�✓ �..��' lf�� `,�Y7r'� .�`y�C ��T�. <br /> i, ' ' ��. ,''�. S ..r.� i�} � t.- �s�.�'� {1t. ' _.f:�,. �*i�_` c"',N � y i �t� + <br /> �1�: -r� _..; ,. i.. r.� �, , � !1�1,� .w .�«�.:,'_ `\ , 4� <br /> ,. <br /> � �;, �.�vc' ;;I <br /> �aC9VATIOPd�i'I2�NCI�IING SATE"fY CII��itLIST � <br /> Date(s) of work: �� —` % - ��Jork ordcr�' ___ <br /> Location of work: iC `% '�i' � r `>'-i S. (�'. <br /> Is a"Competent Person", as defined in WAC 29b-155-650, in chsrge of job?.......................... Yes� No � <br /> HasDial-A-Dig been cailed?......................................................................................................Yes � No � ' <br /> Dial-A-Dig number llate & Time Dial-A-Dig Done <br /> i <br /> Are traffic control devices ir,place?.................. ........................................................................Yes �- NO ❑ � <br /> I Is trench/evacuation on the toe of a hill, slope, or neaz a retainiug wall?................................... Yes � No � ' <br /> (If yes, consult superv:sor or engineer for recommendations.) <br /> 1 <br /> If trench/excavation is less tlian 4 feet deep are sides stable?..................................................... Yes 0 No ❑ <br /> (If not, then trench/excavation nmst be shored.) I <br /> If trench is more than 4 feet deep is shoring in use?...............................,.......:�.......................... Yes [] No ❑ i <br /> /.; i <br /> � Is shoring rated for depth of trench/cxcavation?............................�..:........................... Yes � No [] i , <br /> IIs tabulated data for the shoring on the job site?............................................................. Yes � No Cj � <br /> . � <br /> Are spoil piles ^.nd otlier material stored at lease 2 fect irom tl�e edge of the........................... Yes I�] No � <br /> � <br /> Vencltiexcavation? � <br /> II Is water removed from die bottom of the trei�cl�/escavation?..................................................... Yes 0'_ No [) <br /> Is a ladder avai'zble for entry/exit from trench/excavation?................:...................................... Yes � No � <br /> .__. <br /> Dces it extend 3 iee[ above top of trench?...................................................................... Yes � No ❑ <br /> Is it secured at the to � ..........._...................... Yes � No � <br /> p.................................................................. <br /> Has it been inspected for defects/prc'�lems today?...............:......................................... Yes [J No � <br /> Is there a means of communication with rescuers in the event of an accidendproblem?........... Yes 0 No ❑ <br /> •Are the open sides of the trench/excavation harricaded, or protected, to prevent falls?............. Yes � No � <br /> Is there is a possibility of hazardous atmospheres in the trench/excavation?............................. Yes � No � � <br /> (Such as from leaking gas mains, nearby industries, work over landfills, or other situations.) <br />� If yes, is a calibrated gas detector in use?......................:............::.................................. Yes � No ❑ <br />, If yes, is a mearis pf retri�val available for workers in tlie trencl�/excavation? .............. Ycs � No ❑ <br /> , <br /> Are all workers �n si,c awe•e of safety requirements for workers in trenches/excavations? ..... I'es � No � <br /> / <br /> . // _ <br /> �� Datc: <br /> Signature oi C��c�v I.caJcr: _ �--- - --=- — -------- <br /> ���_,�,���,_��:.,_���:�.,,,,.., <br /> ^.r�,—.���s�� .���. � <br />