Cfn-1031 Upf Daily Trench Safety Report Form - Y-12
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1
2Work Package No:
UPF DAILY TRENCH SAFETY
_______________________
REPORT FORM
Task No.: _______________
Page 1 of 2
Date:
Job No.:
Project Name:
Project Owner:
Competent Person:
Location:
Weather Conditions:
Rainfall amounts 24 hrs. previous:
Depth of Trench: Min. _______
Maximum __________
"I hereby attest that the following conditions existed and that the following items were checked or reviewed during
this inspection": (check appropriate response – checking boldface letter requires additional comment.)
N/A
Y
N
1.
All open trenches were inspected?
2.
Surcharge was located proper distance from toe of slopes?
3.
Were any tension cracks observed along top of any slopes?
4.
Were slopes cut at design angle of repose?
5.
Was any water seepage noted in trench walls or bottom?
6.
Was bracing system installed in accordance with design?
7.
Was there any evidence of caving or sloughing of soil since the last field inspection?
8.
Were there any zones of unusually weak soils or materials that were not anticipated?
9.
Was there any evidence of significant fracture planes in soil or rock?
10.
Were there any noted dramatic dips in bedrock?
11.
Where all short-term trench(s) covered within 24 hours?
12.
Noncompliance items photographed?
13.
Trench box(s) certified?
14.
Were hydraulic shores pumped to design pressure?
15.
Type shoring being used; Secure?
16.
Did shoring plan include adequate safety factor to allow equipment actually being used?
17.
Traffic in area adequately away from trenching operations with barricades?
18.
Trees, boulders, or other hazards in area?
19.
Vibrations from equipment or traffic too close to trenching operation?
CFN-1031, Y17-95-64-822 (11/09)
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