Section 1: Introduction
1. Project / Site Name
2. Excavation Depth, Width and Length (m)
3. Has the Competent Person had training in excavation and trench safety?
Yes
No
N/A
4. Name of Competent Person
Section 2: Soil Analysis
1. Is soil analysis and classification required prior to excavation?
Yes
No
N/A
Section 3: General
1. Has a Risk Assessment been completed by a Competent Person?
Yes
No
N/A
2. When are excavations, adjacent areas, and protective systems inspected by a competent person?
3. Underground utilities located, marked and noted, with operator and relevant personnel informed?
Yes
No
N/A
4. Is Traffic Control in place where required?
Yes
No
N/A
5. Are hard hats and all other appropriate PPE worn by all employees?
Yes
No
N/A
6. Are all employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation?
Yes
No
N/A
7. Are barriers provided at all remotely located excavations, wells, pits, shafts, etc.?
Yes
No
N/A
8. Are walkways and bridges over excavations equipped with standard guard rails and toe-boards?
Yes
No
N/A
Section 4: Protective and Support Systems
1. Type of protective system being used?
2. Protective system appropriate for soil type, trench size and expected loads?
Yes
No
N/A
3. Have materials and equipment used for protective / support systems been inspected by the Competent Person and found to be in good condition?
Yes
No
N/A
Section 5: Access & Egress
1. Are there safe means of egress regularly spaced across space of excavation?
Yes
No
N/A
2. Walkways, bridges, ladders and ramps are in safe, secure positions?
Yes
No
N/A
3. Are all personnel reasonably able to use access and egress?
Yes
No
N/A
4. Are all personnel familiar with emergency, rescue and evacuation procedures?
Yes
No
N/A
Section 6: Sign Off
1. Name & Signature of Competent Person
2. Name & Signature of Site Foreman / Supervisor