Project Information Project Name: Location: Company Name: Date: Time : ITEMS TO BE CHECKED Yes No N/A Comments 1. All open excavations 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 excavation walls or bottom? 6. Was bracing system installed in accordance with design? 7. Was there evidence of significant fracture planes in soil or rock? 8. Was there any evidence of caving or sloughing of soil since the last field inspection? 9. Were there any zones of unusually weak soils or materials not anticipated? 10 Was there any evidence of significant fracture planes in soil or rock? 11. Were there any noted dramatic dips in bedrock? 12. Where all short-term trench(es) covered within 24 hours? 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 for equipment actually being used? 17. Traffic in area adequately away from trenching operations with barriers? 18. Trees, boulders, or other hazards in area? 19. Vibrations from equipment or traffic too close to excavation operation? 20. All open excavations were inspected. 21. List heavy equipment near operation: ___________________________________________________________ __________________________________________________________________________________________ 22. Heavy equipment in use at site: ________________________________________________________________ 23. Contractor at site: ___________________________________________________________________________ 24. Excavation supervisor at site: __________________________________________________________________ 25. Observations: Remarks: Inspected By: Signature: Reviewed By HSE Manager / In charge : Signature:

1. EXCAVATION SAFETY REPORT
(To be completed on Daily basis)
Page 1 of 2 Form # HSEQ – ESR (Rev 2 - Mar 23)
Project Information
Project Name:
Location: Company Name:
Date: Time :
ITEMS TO BE CHECKED Yes No N/A Comments
1. All open excavations 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 excavation walls or
bottom?
6. Was bracing system installed in accordance with design?
7. Was there evidence of significant fracture planes in soil or
rock?
8.
Was there any evidence of caving or sloughing of soil since
the last field inspection?
9. Were there any zones of unusually weak soils or materials
not anticipated?
10 Was there any evidence of significant fracture planes in soil
or rock?
11. Were there any noted dramatic dips in bedrock?
12. Where all short-term trench(es) covered within 24 hours?
13. Trench box(s) certified?
14. Were hydraulic shores pumped to design pressure?
15. Type shoring being used
S
e
c
u
r
e
?
16. Did shoring plan include adequate safety factor to allow for
equipment actually being used?
17. Traffic in area adequately away from trenching operations
with barriers?
18. Trees, boulders, or other hazards in area?
19. Vibrations from equipment or traffic too close to excavation
operation?
20. All open excavations were inspected.
21. List heavy equipment near operation: ___________________________________________________________
__________________________________________________________________________________________
22. Heavy equipment in use at site: ________________________________________________________________
23. Contractor at site: ___________________________________________________________________________

2. EXCAVATION SAFETY REPORT
(To be completed on Daily basis)
Page 2 of 2 Form # HSEQ – ESR (Rev 2 - Mar 23)
24. Excavation supervisor at site: __________________________________________________________________
25. Observations:
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature: