• Trench Inspection

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Note: All unsafe conditions must be corrected before trench entry. If any hazardous conditions are observed during work, the trench must be immediately evacuated.

    Inspect excavations throughout the work shift. If conditions change, complete a new inspection form.

  • Time of Inspection

  • PA One Call

  • Date Completed
     / /
    2 digit month, 2 digit day, 4 digit year

  • Work Practices

  • Traffic Control:
  • Ladder:
  • Water Accumulation:

  • Atmosphere
       O2      CO2      SO2   d

  • Soil Stability

  • Previously Disturbed?
  • At least 2' away from edge?
  • Subject to vibration?
  • Soil Classification
  • Is excavation more than 5 feet in depth?

  • If yes, protective system must be used to prevent cave-in.

  • Protective System Chosen:
  • Type a question
  • Should be Empty: