310 42ND ST SW 2016-01-01 MF Import

� _ �___.` ,-.-_.___..� . - . , . . ...�� ...��'�_- r'4`:i,�:; _ . ._ _ _. .. _ . __ . � 1 .j � �� lx }, 1,�. r' - r �' F° �.� i � I � �XCAVATIONfT12�NCi:iNG SAF�TY CFIECKLIST ; Date(s) of work: �� —�l � VJork order# ��`; Location of work: � �L `�2'�a 'S �� _s ��J � � � Is a"Competent Person", as defined in WAC 296-155-650, in chazge of job?.......................... Ye�No � f: ��a � � I HasDial-A-Dig been called?.................. ................................................................................... Ye��No � . � Dial-A-Dig number Date &Time Dial-A-Dig Done — �,;,;� I Are traffic control devices in place?...........................................................................................Yes�No � i Is trench/evacuation on the toe of a hill, slope, or near a retaining wall?................................... Yes � No� (If'yes, consult supervisor er 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.) . . ................... .................. Yes No If trench is more than 4 feet deep is shormg m use?......................... • • � � ,; � Is shoring rated for depth of trench/excavation?.......................... .... . ....... ................ Yes � Nc � I � ; Is tabulated data for the shoring on the job site?.......................�.................................... Yes � No [� �� Are spoil piles and other mat��.:�:1 s.on.,i �t lr:�:� 3 icci :rc»:� the �.d� �,. ��f ih�. ... 7',- '. '�.?'o LI � trench/excavation? �`� is water removed fram tl�e bouom oi thc ucnci�/c;:c.��'�ition?..............................................._. ... 5'c_�,t'<L i�io ❑ 'E . • ............................ Yes No � Is a ladder available for entry/extt from trench/excavation?..............!....... . . ❑ � A Does it extend 3 feet above top of trench?......................�. . ......,�. .. ....:........................ Yes � No � Is it secured at the to � '....0::.................................. Yes � No [J p............................. ...................... Has it been inspected for defects/problems today?......................................................... Yes [] No � Is there a means of communication with rescuers in the evenl of an accidenUproblem?........... Ye� No � •w� the open sides of the trench/excavation barricaded, or protected, to prevent falls?............. Yc� No�J Is there is a �.ossibility of hazardous a:mospheres in the trench/excavation?............................. Yes � No-�— (Such as from 1e11cing gas mains, nearby industries, �vork over landfills, or o?her situations.) , • ............... Yes No lf yes, is a calibrated gas detector �n use?.......................................: .... . . � � If yes, is a means of retrieval available for workers in the trench/ x v tion? .............. Yes � No � A�e all workers on site aware of safety requirements for workers in trencl�es/excavations? ..... Yes [) No � � �CZ^L_�__ � �^._.��'/ Date: �J�' � ." �'� Signature of Crew Leader: � - roc>u�oucaicr:u�-n+e�ur��) _ - -- — -. --�.-_._..��.�_-- .:R ;rw' �w=�"-�`'- I — - - 'rs"t�s, .—.