Date
07/15/2025
Time
06:30 AM
Employee First & Last Name
Terry Sheeley
Job
Southbend Lead
Excavation Depth
6’
Soil Class
A (1.5 sf)
Have locates to the "811" One Call System been made?
Satisfactory
Are locates active?
Satisfactory
Hand dig in the tolerance zones, 24” for IN. 48” for MI. plus ½ of the pipe utility size:
Satisfactory
Maintain 10' separation to all overhead power lines:
Satisfactory
Utility spotter to help find all buried facilities, and maintain 10' separation on overhead:
Satisfactory
Trench Box
Satisfactory
Trench Boxes On-Site:
9803454
9805828
9805829
Sloping
Satisfactory
Shoring
Satisfactory
Accumulating water being removed:
Satisfactory
Excavation inspected after a rainstorm:
Satisfactory
Excavator inspection forms complete:
Satisfactory
All employee's trained in excavation:
Satisfactory
Bottom of the box is within 2' of the bottom of the excavation:
Satisfactory
Employees are protected from rolling or falling objects into the excavation:
Satisfactory
Ladder in good shape, being used in excavation 4' or deeper, within 25' of employees:
Satisfactory
Spoil pile back at least 2':
Satisfactory
Undermined structures supported: (utilities, sidewalks, buildings, curbs)
Satisfactory
No one within 5' of swing radius of the excavator:
Satisfactory
Unattended or left open excavation is protected with snow fence and barricades:
Satisfactory
Employees wearing proper PPE: (hardhat, class II vest, gloves, safety glasses, safety toe)
Satisfactory
Operator's wearing seatbelts, all equipment is equipped with ROPS:
Satisfactory
Fire extinguisher in the cab and properly secured:
Satisfactory
Back-up & travel alarms are working on all equipment:
Satisfactory
No cracked glass on any equipment:
Satisfactory
All rigging equipment in good shape and has a certified tag or label:
Satisfactory
Signature
Employee First & Last Name
Terry Sheeley