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<br /> �XCAVATION/"IIt�NCIIING SAP'GTY CH�CKLIST
<br /> � _ _ >�' _ Work order d1_
<br /> Date(s) of work: ��- , ;
<br /> �
<br /> � � c�;2 ..� � ��> G✓
<br /> Location of work: 2 �
<br /> : I
<br /> Is a"Competent Person", as defined in WAC 296-155-650, in charge of job?..........................Yes,�No ❑ ' I
<br /> Has Dial-A-Dig been called?....................................................................................................
<br /> ..Yes�No ❑ ' '
<br /> Dial-A-Dig number Date &Time Dial-A-Dig Done
<br /> Are traffic �entrol devices in place? ...........................................................................................Yes� No ❑ I
<br /> Is tcenc;ilevacuation on the toe of a hill, alope, or near a retaining wall?................................... Yes � No� �1
<br /> (If yes, consult supervisor or engineer for recommendations. r,o � ���t'
<br /> )
<br /> ❑ ! I���
<br /> If trencl„excavation is less than 4 feet deep aze sides staUle?..................................................... Yes� '
<br /> (If not, then trench/excavation must b� shored.j � �
<br /> .. Yes No ❑ �
<br /> �.............................r......F... ...................... ❑ :
<br /> If trench is more than h feet deep is shoring in use. ' / ,
<br /> ................... .. .......j�.�...�....................... Yes [] No ❑
<br /> Is shuring rated for depth of trench/excavation?. � Ye; � No �
<br /> Is tabulated data for the shoring on the job site?.................. .......
<br /> .
<br /> Are spoil pilcs and other material stored at lease 2 feet from the edge of the........................... Yes;�--No ❑
<br /> trencl�/exc�vation?
<br /> Is water removed from the bottom of the trench/excavation?..................................................... Yes�No �
<br /> 1 .. .......................Yes ❑ No ❑
<br /> Is a ladder available for entry/exit from trench/excavation?.....••••••••••••••••••••• •
<br /> . ..... ....................
<br /> Yes � No (]
<br /> Does it extend 3 feet above top of trench?.............................:. . ../,.. l yes ❑ No �
<br /> . ...............................
<br /> .... .....
<br /> Is it secured at the top?............................. . ......................................... Yes � No ❑
<br /> Has it been inspected for defects/problems today?.....•••••••••••
<br /> IIs there a means of communication with rescuers in the event of an accidcndproblem?..•�•�••••• Yes�° �
<br /> • Are the open si�les of the trench/excavation barricaded, or protected, to prevent falls?............. Yes'�No ❑
<br /> Such as from leakin gas mains, nparby industries, wor � vatif�n?............................. Yes � No�
<br /> Is there is a ussibilit of hazardous atmos heres in the trench/exover �ndfills, or other situations.)
<br /> r b i
<br /> \
<br /> , ! , Yes � No �
<br /> If yes, is a calibrated gas detector in use?................:..
<br /> ...;..�.... ......................... .............
<br /> If yes, is a means of retrieval available for workers m t�e trench/excavation? ..•••••••••••• Y�s ❑ No �
<br /> Are all workers on site aware of safety requirements for workers in trenches/excavations? ..... Yes [7� No ❑
<br /> , Lj Datc:���' `� �
<br /> Signature of Crew Leader: ����� � ' /
<br /> r�r`.19 f1i1'�ICa'�II A!Slln)51
<br /> � -�11��'� � . . . � . ,i4�p ���1�1�1
<br /> _...._�._ ..�. . � } F 51 .��
<br /> '"_ �_ _ .
<br /> ��au� °��' �1•.� ,:, - .. _ .__ ��_::�. ' ... : . _ . . . . � � � a +�i ,,�
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