PTW No

NGHI SON REFINERY AND PETROCHEMICAL COMPLEX CONSTRUCTION PROJECT

EXCAVATION CHECKLIST
Zone 1 Zone 2 Zone 3 Zone 4 EXACT LOCATION
Excavation Information

Reference drawing number(s) Such as “ As Builts”, Plot Plans, Drawing No.

Construction drawing that show underground services.
1) ________________________________________________

2.) ________________________________________________

3.) ________________________________________________

What and where are they located in relation to the intended work area?
______________________________________

Type and location of any known cables or services in the

vicinity
______________________________________

Type of digging method used e.g. Hand Dig or Excavator

1) ________________________________________________

2.) ________________________________________________

3.) ________________________________________________

Excavation Checklist

Have affected area drawings been checked for hazards Yes:

Any surface or prominent structure on site? (Hard Barricade around structure) Yes:

Is excavation depth greater than 1.2 Metres shall be shored or sloped Yes:

Does the excavation need barricades or steel plate covers? Yes:

Is a Confine Space Checklist Required? (If unsure consult HSE Department) Yes:

Standby Man available if machinery being used in Hazadous areas such as cables structure etc. Yes:

Have Entry/Exit Points and Entry/Exit Stair Etc. been identified and ready to install Yes:

If excavation is excessive with dificult Entry/Exit. Complete an Emergency Rescue Plan Yes:

I declare that the information provided is accurate and the control measures listed above have been
effectively implemented.
Name/ Designation / signature: Date:

I have evaluated the PTW, associated checklist and iam satisfied that all reasonably practicable measures
have been taken effectively. (JGCS Supervisors / Work Site engineers / QC engineers / QC managers)

Name/ Designation / signature: Date: