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��,:.�—'_.-- ._a.. .-. . _:,-�_ylk;dt -31Ts�:en : ,..,,q ..�.' <br /> y...,i.c. . . . . - - �. <br /> 1:,..:+;" _..- . . . <br /> - - . . I:�.,�. � <br /> �r r_ <br /> � <br /> ;;�;���.� <br /> ��"` ,�y <br /> � <br /> ;��.� <br /> ,r�.� <br /> ��t' <br /> ,,'s. A <br /> M'� <br /> � ' <br /> 1 � <br /> EXCAVATION/TItENCHING SAF'ETY CHECKLIST �` <br /> �,� _c� S� __ Work c:der# <br /> �ate(s) of work: <br /> 3.�C' ��,�-.�) S-� S �ti� � <br /> Location of work: . <br /> Is a"Competent Person", as defined in WAC 296-155-650, in charge of Job2.:'.::":�:�...:..:""Ye,� No ❑ � <br /> ,....Yes�No ❑ <br /> Has Dial-A-Dig been called?.................................. <br /> .................................... , <br /> Dial-A-Dig number �— <br /> Date &Time Dial-A-Dig Done <br /> . . ........ <br /> .......................................................Yes�jc No ❑ <br /> Are traffic control devices in place? ........................ • . <br /> Is trench/evacuation on ttie toe o`a hill, slope, or near a retaining wall?...................................Yes ❑ N�- <br /> (If yes, consult supervisor or engineer for recommendations.) <br /> i <br /> �} ....................Yes ❑ No � �, <br /> If trencl(f not, then trench/exca ation must be shored� �le?.................... <br /> . ..... . .I. <br /> . .../.......................Yes � No ❑ '; <br /> If trench is more than 4 feet deep is shoring in use?..........................:�•.• � <br /> ,.,,Yes ❑ No ❑ <br /> Is sho:ing d d aa for�the shoring on the job s�e?............................................................Yes ❑ No ❑ <br /> Is tabulate � <br /> V <br /> Are spoi] piles and other material stored at Icase 2 feet from the edge of the........................... Yes� o ❑ , <br /> trench/excavation? } <br /> I,water removed from the bottom of the trench/excavation?.....................................................Yes� N° ❑ r <br /> ... ......... .... . Yes � No ❑ ; <br /> Is a ladder available for entry/exit from trench/excavation?....................... YeS No � <br /> � iT............... � , <br /> Does it extend 3 feet above top of trench?................................:...i,.••••••,' I ......,.,,......Yes � No ❑ ; <br /> Is it secured at thP to . .................................:....�;...:....;.. ....Yes � No ❑ <br /> . . . . . <br /> , p?.................. . . .. . . . <br /> . . . ............ <br /> . . . . . . . <br /> Has it been inspected for defects/problems today. ....•••••••••••••• • •• ' ' ' ' " ' ' ' <br /> Is there a means of communication with rescuers in the event of an accidendproblem?...........Yes� No � <br /> •Are die open sides of the trench/excavation barricaded, or protected, to prevent falls?..........�..YeS;�- N° O_ <br /> Is there is a possibility of hazardous atmospheresindustriesn o k over landfills, or other situations.� � <br /> (Such as from leaking gas mains, neazby <br /> . . . . <br /> Yes �] No � <br /> . ... :•......i. .. ..... ... . . . ............. <br /> If yes, is a calibrated gas detector in use?...................... .. <br /> If yes, is a means of retrieval available for workers in the r a exc vation? .............. Yes ❑ r�� <br /> Are all workers on site aware of safety requirements for workers in trenches/excavations? ...�Ye j No ❑ <br /> � Date: `� ` 5 � <br /> Signature of Cre�v Leader. <br /> % �,���-�-.%/Y'?'�{��=�— <br /> �..-��...�.�,. - �- -- I <br /> a�:�l.�"l4i:.a�.0 <br />