REL Trench and Excavation
(Complete Daily by Competent Person)
Project
*
Please Select
2800048-PAVH
2800048 -PAVH TEST
Company
*
Please Select
Ruszkowski
Email (a copy of this form will be emailed here)
*
example@example.com
Site Location
*
Date
*
/
Month
/
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Competent Person
*
Soil Type
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1
2
3
4
Excavation Depth
*
Excavation Width
*
Excavation type
*
Stripping
Basement
Cut/Fill
Utility
Borrow
Drainage
Foundation/Footing
Other
Type a question
*
Sloping
Shoring
Trench Box
Other
EXCAVATION GENERAL INSPECTIONS:
Indicate for each item: YES (Y) NO (N) or N/A
A. Traffic Control in place where excavation is close to roadways or public traffic.
*
Please Select
Y
N
N/A
B. Mandatory PPE is worn by all workers.
*
Please Select
Y
N
N/A
C. Excavation is adequately guarded by fence or barricade as required.
*
Please Select
Y
N
N/A
D. Operation/location of equipment & vehicles is not impacting stability of excavation.
*
Please Select
Y
N
N/A
E. Loose material is scaled and trimmed from sides.
*
Please Select
Y
N
N/A
F. Equipment, spoil pile and construction material at least 1 meter from edge.
*
Please Select
Y
N
N/A
G. Excavation wall is not cut back greater than 45° angle.
*
Please Select
Y
N
N/A
H. Kept free from water accumulation.
*
Please Select
Y
N
N/A
I. Slope of spoil pile adjacent to excavation/trench has angle not steeper than 1:1, or 45°
*
Please Select
Y
N
N/A
J. Workers are clear and safe distance from equipment / loading / unloading.
*
Please Select
Y
N
N/A
K. Adequate organization & good housekeeping practices.
*
Please Select
Y
N
N/A
L. Cracks in walls are not present.
*
Please Select
Y
N
N/A
M. No signs of caving or sloughing.
*
Please Select
Y
N
N/A
N. No areas of unusually weak soil.
*
Please Select
Y
N
N/A
UTILITIES:
Indicate for each item: YES (Y) NO (N) or N/A
A. Utilities adequately located and marked (ROL kept current).
*
Please Select
Y
N
N/A
B. Accurately establish exact location of all underground utilities - safe exposure.
*
Please Select
Y
N
N/A
C. Underground installations are protected to prevent damage during backfill.
*
Please Select
Y
N
N/A
ACCESS AND EGRESS:
Indicate for each item: YES (Y) NO (N) or N/A
A. Ladders, stairway or ramps installed in excavations 1.2 m or greater.
*
Please Select
Y
N
N/A
B. Location within 8.0 m from worker and extend 1.0 m from sidewall.
*
Please Select
Y
N
N/A
TEMPORARY PROTECTIVE STRUCTURES:
Indicate for each item: YES (Y) NO (N) or N/A
A. Material & equipment used for protective system inspected and in good condition.
*
Please Select
Y
N
N/A
B. Extends at least 300mm (1 ft) above the wall to prevent material from falling in.
*
Please Select
Y
N
N/A
BACKFILL GENERAL INSPECTION
Indicate for each item: YES (Y) NO (N) or N/A
A. Structure grading and location confirmed by installer(s).
*
Please Select
Y
N
N/A
B. Pipe bed over excavated and replaced with 100mm bedding sand.
*
Please Select
Y
N
N/A
C. Pipe(s) are securely bed at half way of side point.
*
Please Select
Y
N
N/A
D. Pipe bedding compacted at half way of side point.
*
Please Select
Y
N
N/A
E. Pipe bedding compacted again at 300mm above pipe.
*
Please Select
Y
N
N/A
F. First lift above bedding layer installed by tracked skid steer and compacted by trench compactor.
*
Please Select
Y
N
N/A
G. All remaining lifts installed in maximum 300 mm thicknesses and compacted to 98% S.P.D. minimum.
*
Please Select
Y
N
N/A
H. All 300mm lifts have been tested by third party prior to next lift and results submitted to supervisor.
*
Please Select
Y
N
N/A
I. All close vicinity compaction of structures is packed with jumping jack or trench compactor.
*
Please Select
Y
N
N/A
J. Top 300mm of trench is backfilled with Type 33 base compacted to 100% S.P.D. minimum.
*
Please Select
Y
N
N/A
K. Surplus excavated material not required for backfill is removed and site is left tidy.
*
Please Select
Y
N
N/A
CORRECTIVE ACTION:
Provide comments/explanation to all NO (N) responses:
*
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