Contract For Excavation Reporting Form printable pdf download

Contract For Excavation Reporting Form

State of Arkansas

Arkansas Department of Labor

Arkansas Occupational Safety and Health

10421 WEST MARKHAM • LITTLE ROCK, AR 72205-2190

Phone: 501-682-9091

Fax: 501-682-4532

TRS: 800-285-1131

CONTRACT FOR EXCAVATION REPORTING FORM

This form must be completed by any public body (state agency, county, municipality,

school district, or other local tax unit or improvement district) awarding a contract for a

public construction project which will involve any trench or excavation of five feet (5’) or

more. Arkansas Code § 22-9-212.

Name of Public Agency:__________________________________________________________

Address of Public Agency:________________________________________________________

Contact Person:___________________________________Phone number:_________________

Person Filing Report:____________________________________________________________

Name of General Contractor:______________________________________________________

Address:_________________________________________Phone number:_________________

Name of any subcontractor doing trenching or excavation;_______________________________

Subcontractor address:______________________________Phone number:_________________

Estimated start date:_____________________________________________________________

Estimated completion date:________________________________________________________

Site location/address/street/road:___________________________________________________

Arkansas Code § 22-9-212 also requires that the current federal OSHA standard for excavation and

trenching be incorporated into the project’s specifications and that the contract bid form include a

separate pay item for trench or excavation safety systems.

The Arkansas Department of Labor provides free training on trenching and excavation safety.

SEND NOTICE TO:

Arkansas Department of Labor

Safety Division

10421 West Markham Street

Little Rock, AR 72205-2190

(501) 682-9091

fax: (501) 682-4532

e-mail: mike.watson@arkansas.gov

Contract For Excavation Reporting Form