HSE

EXCAVATION CERTIFICATE Code FR_HSE06

Page 1/ 2
Rev 001
Date

Certificate N°: Original associated work permit N:

Location: LNG Tank fondation Date:
Details of excavation:

Attachments
Drawings: Drawing image

Sketches:/
Others: PTW +Method of Statement + Risk Assessment+ JHA and TBT
Known underground services
Cable & pipe diameters, voltage, gas & liquid type, gas & liquid pressure, method of marking, etc.
Electrical Blank area
Gas Blank area
Flammable liquid Blank area
Sewer Blank area
Water main Blank area
Instrument Blank area
Telecom Blank area
Others No thing
Precautions and Mitigations
All known and identified services shall be located and market in the field using wooden pegs Warning light will be used at night
Pilot trenches to be hand dug to a maximum depth of 1.2m per step x Provide means of entering / exiting excavation
Provide means of entering / exiting excavation Required action if service is damaged
Excavation may be carried out by mechanical means after pilot trenches are completed Provide adequate barriers and sign boards
Services tracing equipment is to be used before / during excavation Permanent observer to be provided
Personnel carrying out excavation operations to wear insulating rubber boots / gloves Confined Space Entry Certificate required
Shoring / battering / benching to be applied Additional precautions to be taken:
Permit Authorizer Performing authority Civil Supervisor HSE Supervisor
Date: Date: Date: Date:
Name: Name: Name: Name: ELOUALYDY MOSTAFA
Signature: Signature: Signature: Signature:
 HSE
EXCAVATION CERTIFICATE Code FR_HSE06
Page 2/ 2
Rev 001
Date

Certificate N°: Original associated work permit N:

Certificate N°: 001 Original associated work permit N°: