Demo Site

Pre-Excavation Checklist

Form Progress1/6 sections

COMPANY NAME

Demo Company Inc.

COMPETENT PERSON

DATE

10/18/2026

JOB SITE NAME & LOCATION

Demo Site

SOIL TYPE CLASSIFICATION

SAFETY REQUIREMENTS:

• Excavations shall be inspected daily by the competent person

• Employees in excavations 5 feet or greater in depth shall be protected from cave-ins

• Access/egress shall be located in trench excavations 4 feet or more in depth

• Employees shall not work in excavations with accumulated water without adequate precautions

• Spoils, materials, and equipment must be kept clear at least 2 feet from edge of trench

• Fall protection required for trenches/excavations 6 feet or greater in depth and 30 inches or wider

1. SITE PLAN & WORK DATE VERIFICATION

I have verified the Site plan covers the 'Scope of work'

I have verified the 'Work to begin' date with the Site Supervisor

2. MARKED UTILITIES OBSERVED

(Include on marked-up site plan)

Gas (Yellow)

Cable TV (Orange)

Electric (Red)

Water (Blue)

Telephone (Orange)

Sewer (Green)

3. UNMARKED UTILITIES - VISUAL OBSERVATION

Based on visual observation, did you see signs of any unmarked utilities?

Yes

4. SITE PHOTOGRAPHY

Photograph the entire proposed work area including all locate marks

I have photographed the entire site prior to excavation

I have photographed existing locate/markings

UPLOAD PHOTOS

Click to upload photos

5. CREW SAFETY BRIEFING

Crew members have been advised of the 18" hand dig rule with extreme care and caution within tolerance zone

USA# RESPECT THE MARKS! Only authorized subcontractors may dig on site.

6. EXCAVATIONS 5+ FEET IN DEPTH (WHERE EMPLOYEE WILL ENTER)

Type of protection provided:

Trench Box / Shoring

Benching

Sloped Walls

Does the trench have potential for hazardous atmosphere?

Yes

IN THE EVENT OF DAMAGE:

• Notify the Site Supervisor immediately
• Do not leave the site without checking in with the Site Supervisor
• Photograph entire area and damage location

SIGNATURE OF COMPETENT PERSON

SUBMISSION REQUIREMENTS:

Submission of this document is required 48 hours prior to any excavation and will be subject to USA or similar utility staking as determined by the Site Supervisor or the Owner.