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<br /> �XCAVATION/T12ENCIIING SAI+�TY CH�CKLIST
<br /> Date(s) of work: �' � -��5J Work order#
<br /> Location of work: 3,�3 `��r'� .�� S, LJ ,
<br /> Is a "Competent Person", as defined in WAC 296-155-650, in charge oT jo`�?.......................... Yes [], No � ;
<br /> HasDial-A-Dig been called?...................................................................................................... Yes �. No � j
<br /> Dial-A-Die number Date &Time Dial-A-Dig Done
<br /> Are traffic control devices in place?........................................................................................... Yes � No �
<br /> Is trench/evacuation on the toe of a hill, slope, or neaz a retaining wall?................................... Yes � No-�
<br /> (If yes, consult supervisor or engineer For recommen�ations.)
<br /> If trench/excavation is less than 4 feet deep are side� stable?..................................................... Yes-� No �
<br /> (If not, then trench/excavation must be shored.)
<br /> If trench is more than 4 feet deep is shoring in use?...................................... ...... . . ... Yes � No �
<br /> ............
<br /> Is shoring rated for depth of trench/excavation?...........................��/........ ............. Yes � No �
<br /> Is tabulated data for the shoring on thc job site?............................................................. Yes [] No �
<br /> Are spoil piles and other material stored at lease 2 feet from the edge of the........................... Yes j�No �
<br /> trench/excavation?
<br /> Is water removed from the bottom of die trench/excavation?..................................................... �'es�No �
<br /> Is a ladder available for entry/exit from trench/excavation?................................... .. Yes � No �
<br /> Does it extend 3 feet above top of trench?..................................�. .. %'..�.�...�................. Yes � No �
<br /> ' secured at the to ?...............................................................�..L-.............................. Yes � No �
<br /> Is it P
<br /> Has it been inspected for defects/problems today?......................................................... Yes � No �
<br /> Is there a means of communication with rescuers in tl�e event of an accidenUprublem?........... Yes�- No �
<br /> •Are the open sides of the trench/excavation barricadec, or protected, to prevent falls?............. Yes� No �
<br /> Is tliere is a possibility of hazardous atmospheres in the trench/eYcavation?............................. 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 means of retrieval available for workers in the trench/ex avation? .............. Ycs � No �
<br /> Are all workers on site awaze of safety requirements for workers in trenches/excavations? ..... Yes � r10 �
<br /> Signature of Crew Leader: �l�`n��/i""33°�X�v Datc: �'���� �J
<br /> voaais nnooic�;�0..��on�i9y)
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