BARRICADING CHECKLIST

Responsible Person:
Site Name:
Excavation Max Depth: Excavation Max Width:
Barricading being used? Yes/ No / Shoring Equipment Used? Yes/ No /Not
Not Applicable Applicable
Safety Signage used? Yes/ No / Traffic and Pedestrian Yes/ No /Not
Not Applicable Control being used? Applicable
INSPECTION DATE (visual inspection only) Date Date Date Date Date Date
Indicate compliance in the columns as indicated: Y=Comply; N=Not Comply; NA=Not Applicable
1. Are the Trenches properly shored?
2. Are the excavations properly barricaded?
3. Are there adequate danger signs posted regarding the
excavations?
4. Is the work area properly protected and visible to the
public?
5. Is passing traffic being kept far enough back?
6. Are existing structures sufficiently protected?
7. Is the site tidy and free from rubble?
8. Estimated depth of Excavation / Trench.
9. Estimated width of the Trench.
10.Estimated length of trench.
11. Add Other
12. Add Other
13. Add Other
Additional remarks

Supervisors Signature Date:

Safety Managers Signature: Date:

Page 1 of 1