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EXC"ATION PERMIT <br /> Date: Time: Expiration Date: <br /> Job description/location/work order number(Be specific.) <br /> Have the individuals assigned to this task been trained in excavation safety? ❑ Yes ❑ No <br /> Before Trenching and Excavating <br /> ❑ Soil Classification Distance in feet to utilities, buildings,footings, or pilings <br /> ❑ Type C Distance in feet to sources of vibrations <br /> ❑ Type B ❑ Yes ❑ No Have the owners of utilities been notified, if applicable? <br /> ❑ Type A ❑ Yes ❑ No Has the ground been disturbed previously? <br /> ❑ Stable List the allowable slope. <br /> Indicate if the items below are: necessary, adequate, and/or available. Necessary Adequate Available <br /> personal protective equipment(be specific) <br /> shoring material <br /> signs, barricades <br /> machinery <br /> Check known obstructions: ❑ electrical ❑ telephone ❑ water ❑ sewer ❑ steam <br /> ❑ alarm ❑ drain ❑ process ❑ footings ❑ pilings <br /> ❑ concrete encasement ❑ other(specify) <br /> Excavation method: ❑ Backhoe ❑ Hand dig ❑ Ditchwitch ❑ Other(specify): <br /> Precautions to be taken: ❑ de-energize lines ❑ ground tools ❑ insulate operator <br /> Trenching and Excavating Checklist <br /> Size of the excavation: Depth Width Length Protective system used <br /> for excavation: <br /> Are ground conditions changing (particularly after rainfall)? ❑ Yes ❑ No ❑ Sloping <br /> Is there a concern for the development of a hazardous atmosphere? ❑ Yes [:]No ❑ Shoring <br /> Ensure that the shoring and/or sloping remains adequate as excavation progresses. Indicate the <br /> shoring method used and applicable appendix. <br /> What method shall be used for entry and exit: ❑ stairway ❑ ladder ❑ ramp [ j App. C-Timber shoring <br /> Has there been a change in vehicular and machinery operation patterns? [ ] App. E-Alternative to <br /> timber shore <br />