8823 7TH AVE W 2016-01-01 MF Import

E�CAVATION�I'1tENCI-IING SAFETY CH�CKLIST Date(s) of' work: �—�� —?! S Work order # � 3? S Location of work: �� __._% ,4(/� � - Is a"Competent Person", as defined in WAC 296-155-650, in charge of job? .......................... Yes�, No � HasDial-A-Dig been called? ...................�.............................................................................. Yes� No � l�ial-A-Dig number �--�� Are traffic control devices in place?.. Date & Time Dial-A-Dig Done .......................................................................... Yes� No � Is trencl�/evacuation on the toe of a hill, slope, or neaz a retaining wall? (If yes, consult supervisor or engineer for recommendations.) If trench/excavation is less than 4 feet deep aze sides stable? (If not, then trench/excavation must be shored.) If trench is more tl�an 4 feet deep is shoring in use? ...................... Yes � No� � ......... Yes� No � Yes [� No� Is shoring rated for depth of trench/excavation? ............................................................. Yes � No � Is tabulated data for the shoring on the job site? ............................................................. Yes � No � Are spoil piles and other material stored at lease � feet from the edge of the ........................... Yes,j�( No � trench/excavation? Is water removed from the bottcm of the trench/excavation?........... Is a ladder available for entry/exii from trench/excavation?....... ......................Yes� No� � ........................ Yes � No � Does it extend 3 feet above top of trench? ......................��...............................•••• I es ❑ No � Isit secured at the top? .............................................................._..�........................... ❑ ❑ Has it been inspected for defect�/problems today? ......................................................... Yes � No � I� there a means of communication with rescuers in the event of an accidenUproblem? ........... Yes� No � . Are the open sides of the tr�nct✓excava[ion barricaded, or protected, to p: event falls? ............. Yes � No ❑ Is there is a possibility of hazazdous atmospheres in the trench/excavation? ............................. Yes � No� (Such as from leaking gas mains, neazby indus[ries, work over landfills, or other situations.) If yes, is a calibrated gas detector in use? ....................................��..........: .................... Yes � No � If yes, is a means of retrieval availab!e for workers in the trench/excavation? ..-�... Z'=s ❑ No ❑ Are all workers on site awaze of safety requirements for �� rke ' trenches/excavations? ..... Yes �] ?`'o � Sig��ature of Crew Leader: ._ ..�,.�T" " " `/'/ ?z��l�i�� Datc:_ �— /� ` %� � � � . � vort.+�smnwia:�(iniwuies) �