319 42ND ST SW 2016-01-01 MF Import

�� - . :� : ,.,,� -, _ - - ._ __...��-.� . _� -- '� ' �� . '-Yy,� T1 ,-7 .h+N� �� , ar , � � ;.� ' �XCE�VATION/TRENCFIING SAF'ETY CFIECKLIST `'�3 I);lte(s) of work: 4� � 2' 9 S Work order#_ ��: ' � ��f , � � I.ocation of work: 3 ��J y�2^�d S� 'S . � ' Is a"Competent Person", as defined in WAC 296-155-650, in charge of job?..........................Yes�No � i� '' � Has Dial-A-Dig been called?...................................................................................................... Yes�o ❑ � '� Dial-A-Dig number Date &Time Dial-A-Dig Done �jt�;!I, � Are traffic control devices in place?...........................................................................................I'es �`No ❑ �";��a Is trench/evacuati�n on the toe of a hill, slope, or near a retaining wall?................................... Yes � No�, (If yes, consult supervisor or engineer:or rccommendations.) If trench/excavation is less than 4 feet deep aze sides stable?..................................................... Yes��No � (If not, then trencl�/excavation must be shored.) If trench is more than 4 feet deep is shoring in use?................................................................... Yes��No � Is shoring r�ted f'or clepth of trench/excavation?......................... ..�.. ...f.�. ...: Yes � No [) Is tabulated data for the shoring on the job site?.....................��1....l....•`-.................. Yes � No ❑ Are spoil piles and other material stored at lease 2 feet from the edgc of the........................... Yes�No � trencl�/excavation? Is water removed from the bottom of the trenct�/excavation?..................................................... Yes�No ❑ Is a ladder available for entry/exit from trench/excavation?................... ....... ... . .................... Yes � No � it extend 3 feet above top of trench?.......................... .. ... ./�/. .�.....�. .. ................ Yes � No � Dot secured at th�top?....................................................... ........................................... Yes [] r`o ❑ ?-�as it been inspected for defects/problems today?.... .................................................... Yes [� r�o ❑ Is there a means of communication with rescuers in the event of an accidenUproblem?........... Ye�J No � •Are the open sides of the trench/excavation barricaded, or protec:ed, to prevent falls?............. Yes'� No � Is there is a oossibility of hazardous atmospheres in the trencl�/excavation?............................. Yes � No`�. (Such as from leaking gas mains, nearby industries, worl:over landfills, or other situations.) If yes, is a calibrated gas detector in use?......................................................... /�. Yes � No � If yes, is a means of retrieval available for wcrkers in the trenet�/excavation�-..'............ Yes � No � Are all workers on site aware of safety requirements for workers in trenches/excavations? ..... Yes � No � n Date: �� ^ �� Signature of Crew Leader. "� — — FORVfS IIDOOICFL�LAICJU:95) __ �s�- " -. . . . `---�