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JOB #: |
DATE: |
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| TIME OF INSPECTION: |
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USAN#: |
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| WEATHER CONDITIONS: |
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OSHA NOTIFICATION: |
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Yes No |
TEMP.: |
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| SUPERVISOR: |
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COMPETENT PERSON: |
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| DIMENSIONS: |
DEPTH = |
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Yes No HAZARDOUS CONDITIONS |
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TOP = W |
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L |
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□ □ Saturated soil / standing or seeping water |
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BOTTOM = W |
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L |
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□ □ Cracked or fissured wall(s) |
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| SOIL TYPE: |
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TESTED: |
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□ □ Bulging wall(s) |
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| Type A Solid rock (most stable) |
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□ Yes □ No |
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□ □ Floor heaving |
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| Type B |
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□ Thumb |
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□ □ Utilities Supported |
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| Type C (loose sand or fill) |
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□ Penetrometer |
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□ □ Super-imposed loads |
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| Previously Disturbed |
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□ □ Vibration Near Excavation |
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| Cohesive Non-cohesive |
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□ □ Ventilation Required |
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| PROTECTION METHODS:(Walls MUST be vertical—NO voids) |
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PLACEMENT OF SPOILS & EQUIPMENT |
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| SHORING |
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□ □ Spoils at least 2 feet from edge of trench |
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| Timber |
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□ □ Subject to surcharge from equipment |
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| Pneumatic |
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□ □ Backhoe at end of trench |
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| Hydraulic |
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□ □ Compressor, etc. at remote location |
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| Screw Jacks |
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LADDER LOCATION |
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□ □ Located in protected area |
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□ □ Within 25 feet of safe travel |
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| SHIELDING / SLOPING or BENCHING |
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□ □ Secured |
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| Trench Box |
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□ □ Extends 36 inches above the landing |
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| Sloping/Bench: B 1:1 (45°) C 1½:1 (34°) |
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□ □ Leads to safe landing |
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| Yes No ENVIRONMENTAL CONDITIONS: |
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OTHER: |
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| □ Air Monitor used? |
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□ Shoring equipment inspected prior to use? |
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| □ Confined space permit issued? |
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□ Is trench SAFE to enter? |
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| DATE |
INSPECTED BY: |
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INITIALS |
DATE |
INSPECTED BY: |
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INITIALS |
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| NOTE: All unsafe conditions must be corrected prior to trench entry. If any hazardous conditions are observed, the trench must be immediately evacuated and no one allowed to re-enter until corrective action has been taken. |
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ENTRY AUTHORIZED BY:(COMPETENT PERSON) |
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