Daily Trench/Excavation Checklist
UNCH Surgical Tower
This checklist is required to be completed prior to entry into an excavation or trench. It ensures the excavation/trench is safe for entry. It verifies utility markout, confirms safe access, safe soil conditions and the installation of protective systems, etc.
General Information
Today's Date
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Name of the Excavation Competent Person completing this form:
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First Name
Last Name
Company name:
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Location of Excavation Description
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1.2
Breif Description of Work
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1.3
Description of Trenching/Excavation Equipment
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Verification of Dig Permit / 811 (if/when required)
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Please Select
Yes
Not Applicable
1.5
Start Date:
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-
Month
-
Day
Year
1.6
Expected Completion Date
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-
Month
-
Day
Year
1.7
Depth (feet)
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Do not exceed 20' without Professional Engineer's design.
Width (feet)
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1.9
Length (feet)
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1.10
Inspection
What type of soil tests were made?
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Visual
Manual
Other
Type of Soil
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Stable Rock
Type A
Type B
Type C
Protective system(s) used
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Trench Box
Sloping
Benching
Shoring
Other
Are there structures/utilities/nearby objects that might become unstable? (If yes, enter type and method of protection below)
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No
Yes
Public Exposure? (If yes, enter type and method of protection below)
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No
Yes
Visual check for unmarked utilities completed (manholes, etc.)? If No, enter comments below
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Yes
No
Utility survey drawings and contract drawings checked? (As-built)
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Yes
No
Have all employees received trenching and excavation training? (If No, remove any untrained worker(s) and notify Skanska EHS
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Yes
No
Daily Checklist
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Yes
No
N/A
Excavations, adjacent areas, and protective systems inspected daily by the competent person before start of work and after changed conditions (rain event)
Employees are protected (struck by, emmisions, etc.) vehicular traffic and equipment
All surface encumberances (signs, poles, structures, buildings, roadways, sidewalks, walls, foundations, etc.) are removed or supporteed to safeguard employees
All spoils are kept at a minimum of two (2) feet from the edge of the excavations or retaining devices are utilized
Barriers are provided around the perimiter of all excavations
Walkways over excavations have guardrails
Utility comanies contacted, utilities located and marked
Underground installations protected, supported, or removed
Stairway, ladder, or ramp provided in trenches/excavations four (4) feet in depth ( employee ramps designed by competent person , structural ramp for equipment designed by a person qualified in structural design) within 25 feet of travel distance
Employees are protected from cave-ins when entering and exiting the excavation
Employees are protected from the the accumulation of water (surface water diversion, well-point system, water pumps, etc.)
Where hazardous atmosphere exists or is expected to exist, the atmosphere has been tested before employees enter the excavation
Members of the support system are correctley fastened to prevent system failure
Excavations below footings or foundations designed by RPE
Removal of support systems progresses from the bottom and members are released slowly as to note any indication of possible failure
Backfilling progressing with the removal of the support system
Excavation of material to a level no greater than two (2) feet below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth
Shields installed to restrict lateral or other hazardous movement
Employees are not in the shield system during any movement (horizontal or vertical)
Tabulated data for protective systems available on site
Signature of Competent Person
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Submit
Should be Empty: