SDWMR Field Forms

Project Date Prepared By Weather

Daily Report

Capture labor, equipment, visitors, delays, and a field narrative.

Work Area Shift Crew Count Equipment Used

Work Performed

Delays / Impacts Visitors / Inspections

Equipment Safety Checklist

Document daily equipment inspections, hazards, corrective actions, and operator sign-off.

Equipment	ID / Unit #	Operator	Checklist Item	Status	Corrective Action	Sign-Off

Sign-In Sheet

Record employees, subcontractors, start times, end times, and signatures.

Name	Company	Role	Start	End	Signature

Safety / Notes

Use this for toolbox topics, incidents, photos to attach later, and PM follow-up.

Toolbox Topic Incident / Near Miss

Safety Notes PM Follow-Up

ROCIP 6 Check List

Pre-excavation checklist based on the ROCIP excavation and trenching permit form.

Open PDF

Excavation & Trenching Check List

Miss Utility Permit # Checklist Date

Section 1 - Preparation

Contractor's qualified person or safety manager completes Section 1.

Job Name / Contract Number Name of Contractor Location of the Excavation Work Description of Excavation Work Third Party Utility Locating Company Name Locator Employee Name

Private Utilities Verification Signatures

Items Required Prior to Opening an Excavation	Yes	No
Pre-planning meeting with DC Water
Plans reviewed for existing utilities
Utility grid sweep conducted of the entire excavation area and 5 feet beyond marked excavation perimeter
Pre-excavation photos taken showing utility markings prior to excavating
Utilities marked and utilities physically / visually located by hand dig, pot hole, or hydroexcavate

Section 2 - Excavation

Contractor's competent person completes Section 2.

Competent Person Name Soil Type Slope Ratio Protective System Used Excavation / Trench Depth Excavation / Trench Width

Soils that have been previously disturbed, such as existing utilities or sewer, are classified as C type soils.

Section 3 - Hazard Assessment and Control

Contractor's competent person completes Section 3.

Controls to be Implemented	Completed	N/A
Competent person has inspected excavation, adjacent areas, and protective systems prior to employees performing work in the excavation / trench.
Professional engineer was obtained to approve excavation of greater than 20 feet depth.
Trench area has restricted access via physical barrier for vehicle traffic and guardrails or fencing 6 feet back for pedestrian protection.
Employees protected from loose rock / soil that could pose a hazard by falling or rolling into the excavation / trench.
Trench is shored and / or sloped per CFR 1926 Subpart P requirements.
Trench is free from standing water and other contaminants.
Excavated material, equipment, and other items will be placed at least 2 feet from edge of trench.
Employees are prohibited from working under suspended loads.
Walkways and bridges over excavations / trenches 6 feet or more in depth have standard guardrails and toe boards.
Trench box system meets regulatory requirements. Tabulated datasheets are available on site.
Underground utilities protected, supported, or removed when excavation is open. P.E. may be required for supporting utilities.
Wood used for shoring or bracing is in good condition and free from defects.
Ladder provided in trench greater than 4 feet depth with ladder extending at least 3 feet above top of trench.
Ladder, ramp, or stair is provided within 25 feet of all personnel working in trench.
Air testing was performed at 4 feet depth or more for oxygen, LEL, and toxics.
Soils classified as B type soil shall have first bench 6 feet.

Air Testing Results

Section 4 - Approvals

I have reviewed this permit and all conditions and agree that work can proceed safely.

Contractor Project Manager Name & Signature Project Manager Date Competent Person Name, Title & Signature Competent Person Date

JARR CARD

Job Assessment Risk Review card with hazards, controls, job steps, employee sign-off, and closeout.

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JARR

Job Assessment Risk Review

Project Date Company Supervisor Safety Rep Completed By First Aider Permit # Emergency #

Describe the Task

NO = STOP WORK Proper locates NOP / Form 1000 Overhead hazards visible

Job Steps

Identify job steps, hazards, and controls for each step.

Job Step	Hazards	Controls

Nearest First Aid / Medical Assistance Muster Location Identify Emergency #

Employee Sign-Off

By signing, employees acknowledge identified hazards, required controls, and PPE inspection before use.

Employee Name / Company	Signature	Start	Mid-Day	End of Shift

Job Completion

Job completion / protection / temporary jobsite securement measures

All permits closed out? Work area cleaned / barriers as necessary? Hazards remaining?

Remaining Hazards Explanation Accidents / Incidents / Safety Opportunities / Near Misses

Supervisor Name Supervisor Signature Date

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