Rev.

00 Date 27/10/09

Page. 1 of 1
S/N ITEMS DESCRIPTIONS Yes No N/A REMARKS/ SUGGESTION ACTION PARTY
1 Is Ground survey/ soil test done before
work commencement
2 Is there an Approved excavation plan &
sketch by a competent person for
excavation greater than1.5m
3 Are the Location of all ground services
marked before digging, using pilot
trenches
4 Has an approved PTW & Excavation
certificate obtained prior to work
commencement
5 Is there a certified First Aider & First Aid
materials/box on site
6 Is gas tester available, calibrated and
ready for use?
7 Is Oxygen equal to or less than 20%, is
Lower Flammable Limit (LFL) greater than
1% and Occupational Explosion Standard
(OES) is half
8 Is there adequate ventilation & lighting
and temporary shelter
9 Are competent workers been used on site
10 Is there either graded sides or appropriate
side supports in place (shoring)
11 Is there warning signs, barriers &
reflective signs
12 Are only trained and certified operators
permitted to operate motorized
excavation equipment
13 Is Drivers certified
14 Is there a standby emergency equipment
15 Are there pump ,drainage, & dig trenches
available in case of flooding
16 Is access Restricted to only authorized
persons?
Inspected by Verified by

Name, Signature and Date Name, Signature and Date