Cfn-1031 Upf Daily Trench Safety Report Form - Y-12 Page 2

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Work Package No:
UPF DAILY TRENCH SAFETY
_______________________
REPORT FORM
Task No.: _______________
Page 2 of 2
20.
List heavy equipment near operation:
21.
Heavy equipment in use on site:
22.
Contractor personnel by trade on site:
23.
Excavation supervisor on site was:
24.
Compliance photo activity by station number and direction:
25.
Changed subsurface condition from those anticipated:
26.
Activity by station:
Trench Box
Man Hole Construction
Side Sloping
Bracing
Other
27.
Observations:
28.
Resolution of Comments/Discrepancies:
_______________________________________
_____________________________________________
Supervisor or Contractor Representative
Competent Person
________________________________________
Safety Coordinator
  
CFN-1031, Y17-95-64-822 (11/09)

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