This Is Intended As a Comprehensive Psychomotor Skills Checklist and Is to Be Used to Document
Of
Homeland Security / Operations Level
Training Program / Trench & Excavation Rescue Module / Master Checklist
JPR's
Student Name:
This is intended as a comprehensive psychomotor skills checklist and is to be used to document student skills practice.
Directions: A master checklist must be completed for all students.
As any of the listed skills are completed, the instructors / evaluators shall complete Part 1 to document such opportunities up to two (2) times.
Student must be afforded an opportunity to practice those skills prior to the skills evaluation. Performance of skills is dependent on the “usual and customary” practices of the jurisdiction(s) having authority.
Instructors must record both the date(s) that the skill was completed and their respective initials. When the skill is performed satisfactorily, the "Sat." column should be checked. However, if the skill is NOT performed satisfactorily, then the "Unsat." column should be checked. If a student was not afforded an opportunity to complete any of the skills, instructors / evaluators must document such by writing "NA" in the "Sat." box.
Part 1: Psychomotor Trench Rescue Operations Skills Practice Checklist
Skills Practiced / NFPAStandard / Date / Initials / Sat. / Unsat. / Date / Initials / Sat. / Unsat
00:01Personnel being evaluated at the
operations level shall meet all
awareness requirements for trench,
rope, confined space, and vehicle /
machinery as specified in NFPA
1670. / 11-3.1
00:02 Personnel operating at the
operations level shall be able to operate
safely and effectively at trench and
excavation emergencies, including the
collapse or failure of individual,
nonintersecting trenches with an initial
depth of 8 ft (2.44 m) or less. / 11-3.2
Skills Practiced / NFPA
Standard / Date / Initials / Sat. / Unsat. / Date / Initials / Sat. / Unsat
00:03 Personnel operating at the
operations level shall be able
to operate safely and effectively at
trench and excavation emergencies
where no severe environmental
conditions exits, digging operations do
not involve supplemental sheeting and
shoring, and only traditional
sheeting and shoring is used. / 11-3.2
00:04 Personnel operating at the trench
operations level shall meet all
requirements for rope, confine space,
and vehicle / machinery operations
levels. / 11-3.2
00:05 Personnel operating at the
operations level shall meet all awareness
and operations level requirements
regarding Hazards Material as
specified in NFPA 472, Standard
for Professional Competence of
Responders to Hazards Material
Incidents. / 11-3.1
01: 00 Size up
01:01 Identification of resources
necessary to conduct
safe and effective trench /
excavation rescue operation. / 11-3.3 (1)
01:02 Implement procedures
initiating a one call utility
location service. / 11-3.3 (6)
01:03 Implement procedures for
carrying out site control and
scene management. / 11-3.3 (1)
01:04 Establishment of control
zones. / 11-3.3 (1)
01:05Recognition of unstable areas
associated with trench and
excavation emergencies and
adjacent structures. / 11-3.3 (3)
01:06 Prohibit entry into an unsafe
trench/excavation. / 11-3.3 (5)
01:07 Prevent movement or
operation. / 11-3.3 (1)
01:08 Size-up of existing and
potential conditions. / 11-3.3 (1)
01:09Implement procedures to
identify probable victim
locations and survivability. / 11-3.3 (4)
Skills Practiced / NFPA
Standard / Date / Initials / Sat. / Unsat. / Date / Initials / Sat. / Unsat
01:10 Identification of a bell-bottom
excavation (pier hole) and its
associated hazards. / 11-3.3 (9)
02:00 Establish tool / equipment
area
02:01 Identify tools needed to
perform rescue operations
at a trench / excavation
incident. / 11-3.3 (5)
02:02 Assemble equipment used
shoring, digging, patient
packaging and monitoring. / 11-3.3 (5)
02:03 Test/inspect equipment prior
to being used. / 11-3.3 (5)
02:04 Inventory and documentation
of all tools. / 11-3.3 (5)
02:04 Demonstrate the proper use of
power saws / 11-3.3 (5)
02:05 Demonstrate the proper use of
chain saw. / 11-3.3 (5)
02:06 Demonstrate the proper use of
air monitoring equipment. / 11-3.3 (5)
02:07 Demonstrate the proper use of
ventilation equipment. / 11-3.3 (8)
02:08 Demonstrate the proper use of
de-watering equipment. / 11-3.3 (5)
02:09 Demonstrate the proper use of
pneumatic jacks / shores. / 11-3.3 (5)
02:10 Demonstrate the proper use of
screw jacks. / 11-3.3 (5)
02:11 Demonstrate the proper use of
all power tools used by the
AHJ. / 11-3.3 (5)
02:12 Demonstrate the proper use of
all hand tools used by the
AHJ. / 11-3.3 (5)
03:00 Soil Types
03:01 Describe the various
classification of soil / 11-3.3 (7)
03:02 Identify accepted visual or
manual testing methods. / 11-3.3 (7)
04:00 Pre-entry / Documentation
04:01 Conduct a pre-entry briefing,
with consideration of the
following: / 11-3.3 (12)
04:02 Tactical assignments. / 11-3.3 (12)
04:03 General Hazards and safety
instructions. / 11-3.3 (12)
04:04 Communication protocols,
procedures, and details. / 11-3.3 (12)
04:05 Environmental concerns. / 11-3.3 (12)
04:06 Time frames for operations. / 11-3.3 (12)
04:07 Emergency procedures. / 11-3.3 (12)
04:08 Specific equipment needs. / 11-3.3 (12)
Skills Practiced / NFPA
Standard / Date / Initials / Sat. / Unsat. / Date / Initials / Sat. / Unsat
04:09 Debriefing procedures. / 11-3.3 (12)
04:10 Anticipated logistical needs. / 11-3.3 (12)
04:11 Implementation of
documentation procedure,
with consideration of the
following: / 11-3.3 (13)
04:12 Identification of IMS
command structure. / 11-3.3 (13)
04:13 Time of incident. / Total
time of operations. / 11-3.3 (13)
04:14 Environmental conditions. / 11-3.3 (13)
04:15 Location of victim. / 11-3.3 (13)
04:16 Creation of a tactical
checklist that includes entry
times, exit times, personal
accountability, atmospheric
readings, rehabilitation
information, injuries
sustained, and incident
number. / 11-3.3 (13)
05:00 Entry
05:01 Implementation of procedures
for making the rescue area
safe including: / 11-3.3 (10)
05:02 Utilizing sheeting and shoring
to stabilize trench/excavation
walls. / 11-3.3 (14)
05:03 Making the trench /
excavation safe for entry. / 11-3.3 (10)
05:04 Placing ground pads at lip of
trench/excavation. / 11-3.3 (10)
05:05 Ventilating the trench and
monitoring its atmosphere. / 11-3.3 (8)
05:06 Establish / assist with setting
up de-watering equipment. / 11-3.3 (5)
05:07 Support unbroken utilities. / 11-3.3 (5)
05:08 Provide PPE for victim. / 11-3.3 (5)
05:09 Implement disentanglement
operations. / 11-3.3 (18)
05:10 Implementation of entry and
egress paths. / 11-3.3 (11)
06:00 Roles and Responsibilities
06:01 Performs the roles, functions,
and responsibilities of the
following: / 11-3.3 (16)
06:02 Panel team. / 11-3.3 (16)
06:03 Entry team. / 11-3.3 (16)
06:04 Shoring team. / 11-3.3 (16)
06:05 Support team. / 11-3.3 (16)
07:00 Extrication
07:01 Implementation of procedures
for assessing the mechanism
of entrapment. / 11-3.3 (17)
07:02 Implementation of procedures
for performing extrication. / 11-3.3 (18)
Skills Practiced / NFPA
Standard / Date / Initials / Sat. / Unsat. / Date / Initials / Sat. / Unsat
07:03 Packed or assist with
packaging victim for removal. / 11-3.3 (18)
07:04 Provide initial medical
treatment and provides
pertinent information
concerning victim to EMS
by AHJ protocols. / 11-3.3 (13)
08:00 Sloping / Benching
08:01 Implementation of procedures
for sloping and benching
systems. / 11-3.3 (15)
Student Comments: (The student is encouraged to respond to the contents of this checklist. If the student does not wish to make any comments, then "NA" should be written in this space by the student.)
Student’s Signature: Date:
Instructor Acknowledgment: I certify that this document has been reviewed by the above named participant.
Instructor's Signature: ______Date: ______
Affiliated Agency:
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