327 42ND ST SW 2016-01-01 MF Import

�:�...�. ,. ;: _�.._ . ��.,,,�� ._ _ _ . --- ' -- �� {f�.�.�,, {'!i'✓N�Yj.� �+�_��WT _..4� ,�� EXCAVATION/TR�NCfIING SAFETY CHECKLIST 4 .. � l�- � - % �J Work order# , �,�;� �ate(s) of work: , � F � � .�; 3.2? `��N°� s' � -0 .,,, ,ocation of work: — • • e of ob?..........................Yes�No ❑ ; �. �.•, ; a"Competent Person", as defined in WA� 2�6-155-650,m charg J , , ....................Yes�No 0 ' �� ............................. ................... � �� ;Ias Dial-A-Dig been called?..........•••••••••••••••�•••""' Done_�— � Date &Time Dial-A-Dig � ,y Dial-A-Dig number _---- Y�S � No 0 ... ....................................................... Are traffic control devices in place. .............. .. .... . I s trench/evacuation on the toe of ahill, slope, oc near a retaining wall?•••••••••••�••""""""""•••••YC5 � No-� (If yes, consult supervisor or engineer for recommcndations. If trench/excavation is less than 4 feet deep aze sides stable?.•••••••••••�••••••""""""""�� YeS�`No O � (If not,flien trench/excavation must be shored.) � , No n Yes ❑ , .....................�7...... .... yes[� No ❑ ; ....................... lf trench is more than 4 feet deep is shoring in use........ / � �..., ............................. Is shoring rated for depth of tre on the jobfion7.::::......:.. :�}^;: � ....................................Yes ;] No ❑ Is tabulated data for the shoring 'l iles and other material stored at lease 2 feet from the edge of the•.•••••••�•••••"""'••••• YeS�'No ❑ � �e spoi p C. trench/excavation? T � .... ...................Yes� Ivo ❑ Is water removed from the bottom of the t[ench/excavation?.............................. YeS O No ❑ �� � / ❑ NO Is a ladder available for entry/exit from trench/excavation?.••••••••••••••••••" �""''" Yes � � / i� Does it extend 3 feet above top of trench?...'..::..:..::.•..::.';::::�i:l:.�. . .. .... .....................Yes ❑ NO ❑ • ..... .................Yes ❑ No ❑ Is it secured at the top?•�•�••••••••••••••" ' ' � ......... Has i[been inspected for defects/problems today ••••••••• Is there a means of communication with rescuers in the event of an accidenUproblem?••••••••••• YeS� N0 � t revent falls?............. Yes� No ❑ ,�pre the open sides of the trench/excavation barricaded, or protected, o P � No� ' as mains, nearbY industries, work over landfills, or other situations.) Is there is a possibility'akm a� ous atmospheres in the trench/excavation?.�••••••�••••••••••••�••••••� es (Such as from � � No 1 . . .........Yes ❑ ' " No ❑ xcavation. .............. Yes ❑ . . ... . .� .. If yes, is a calibrated gas detector in use?.•••••••••••••••••••"�""�"' � �'� • If yes, is a means of retrieval available for workers in the tr�n qre all workers on site aware of safety requirements for workers in trenches/excavations? .....Yes�--No ❑ r1 ,�'/ � "�� .� � -� a�:-� ✓� 4% '��% Date: Signature of Crew Leader: ._ - ; — - ,�.