Professional Documents
Culture Documents
Excavation Work Permit
Excavation Work Permit
Hazards are associated with this work: Yes No NA Hazards are associated with this work: Yes No NA
Vehicle Movement Utilities/ Overhead Electric Cables
Unguarded Edges Uneven Floor Surfaces
Manual Handling of Loads Falling Objects / Debris
Lack of Space Hazardous Atmosphere
DESCRIPTION OF RISK YES NA COMMENTS & ACTIONS
1 Design and method of excavation approved from the consultant according to risk.
Adjacent areas and protective systems inspected & ensured by a competent person before the
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start of work.
3 Protection arrangements done on loose rock/soil that could pose a hazard by falling into
excavation.
4 Materials, and equipment set back at least 2mtr from the edge.
5 Physical Barriers provided at all located excavations, wells, pits, shafts… etc.
Warning system established and utilized for mobile equipment operating at edge of excavation.
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7 Utility companies contacted and/or utilities located. Exact location of utilities marked.
8 Underground utility, installations identified & protected, supported, or removed.
Energized electrical systems (at underground and overhead) are de-energized (locked out)
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11 Inspections are made after every rainstorm or other hazard increasing occurrence.
Adequate precautions adopted for personnel from exposure to an oxygen deficiency,
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combustible/harmful contaminant exposure and/or to other hazardous atmospheres.
13 Emergency preparedness plan & requirements readily available.
Materials and equipment of support systems selected based on soil analysis, trench depth and
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expected loads.
15 Plant and Equipment's inspected & verified for the job and in good condition.
Protective systems installed without exposing personnel to the hazards of cave-ins, collapses,
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or threat of being struck by materials or equipment.
Does the work involve any of the following? Yes / No - (If Yes, use appropriate permits in addition)
Hot Work Work at height Isolation (LOTO) Confined Space
In the event an emergency, call (Phone):
CONTRACTOR AUTHORISED PERSON (i.e.Site Eng. / Supervisor) - (PERMIT GENERATOR )
Requesting and confirming by contractor’s representative: I confirm that the precautions specified above is complied with and the persons
carrying out the work are fully briefed on the safe method of work.
Name Signature Date
CONTRACTOR COMPETENT PERSON WITH COLLIERS REPRESENTATIVE (i.e.Site Eng. / Manager) - (PERMIT ISSUER)
Confirmation:
I understand and certify that the precautions are adopted for excavation work according to above check points and approved SWMS.
Name Signature Date
1. This completed Excavation Work Permit is to be hanged at the work to be conducted and along with approved SWMS.
Note: 2. The work cannot be allowed, if the permit is not signed from authorized person.
3. The Permit is valid for one shift / for 8hrs, If the work extends beyond the shift, new permit to be generated.