Trenching & Excavation Inspection Form

Excavations and Protective Systems inspected by Competent Person daily, before start of work. Required

Yes

N/A

Competent Person has authority to remove workers from excavation immediately. Required

Yes

N/A

Surface encumbrances supported or removed. Required

Yes

N/A

Employees protected from loose rock or soil. Required

Yes

N/A

Hard hats worn by all employees. Required

Yes

N/A

Spoils, materials, and equipment set back a minimum of 2' from edge of excavation. Required

Yes

N/A

Barriers provided at all remote excavations, wells, pits, shafts, etc. Required

Yes

N/A

Walkways and bridges over excavations 6' or more in depth equipped with guardrails. Required

Yes

N/A

Warning vests, or other highly visible PPE provided and worn by all employees exposed to vehicular traffic. Required

Yes

N/A

Employees prohibited from working or walking under suspended loads. Required

Yes

N/A

Employees prohibited from working on faces of sloped or benched excavations above other employees. Required

Yes

N/A

Warning system established and used when mobile equipment is operating near edge of excavation. Required

Yes

N/A

Utility companies contacted and/or utilities located. Required

Yes

N/A

Exact location of utilities marked when near excavation. Required

Yes

N/A

Underground installations protected, supported, or removed when excavation is open. Required

Yes

N/A

Precautions taken to protect employees from accumulation of water. Required

Yes

N/A

Water removal equipment monitored by Competent Person. Required

Yes

N/A

Surface water controlled or diverted. Required

Yes

N/A

Inspection made after each rainstorm. Required

Yes

N/A

Atmosphere tested when there is a possibility of oxygen deficiency or build-up of hazardous gases. Required

Yes

N/A

Oxygen content is between 19.5% and 21%. Required

Yes

N/A

Ventilation provided to prevent flammable gas build-up to 20% of lower explosive limit of the gas. Required

Yes

N/A

Testing conducted to ensure that atmosphere remains safe. Required

Yes

N/A

Emergency Response Equipment readily available where a hazardous atmosphere could or does exist. Required

Yes

N/A

Employees trained in the use of Personal Protective and Emergency Response Equipment. Required

Yes

N/A

Safety harness and life line individually attended when employees enter deep confined excavation. Required

Yes

N/A

In all trenches 5 feet or deeper each employee shall be protected from cave-ins using one or more of the following systems: Required

Shield System

Shoring System

Trenches 4 feet or deeper have means of access/egress? (Ladders must be located within 25 feet of all workers.) Required

Yes

N/A

Ladders extend 36" above top of protective system or top of the trench? Required

Yes

N/A

Shoring equipment been inspected for damage? Required

Yes

N/A

The excavation extends below the bottom of the support system no more than 2 feet? Required

Yes

N/A

Where there is exposure on the open end of the support system, protective steel end plates are used to prevent cave-ins? Required

Yes

N/A

A traffic control plan has been implemented? Required

Yes

N/A

Will overnight protection be required? Required

Yes

N/A

TRENCHING & EXCAVATION ONSITE INSPECTION CHECKLIST