PERMIT TO WORK - EXCAVATION

Project Date:

Permit No Time:

Section I, II and IV to be filled by Site Engineer / Supervisor

SECTION I – (REQUEST FOR PERMIT)

 DFC / Subcontractor: Plant / Equipment to be used

Location / Area: (Attach Drawing) 1
Kind of Activity: 2
Depth of Excavation: 3
Slope: 4

SECTION II
Prior to excavation on site please comply to the following:

1) Check temporary services (MEP). 7) Barriers to prevent person falling.

2) Check permanent services (Local Authorities) 8) Barriers if vehicle crossing.

9) Excavation not undermines other structure, scaffold or

3) Is cable detector used to verify above.
foundation.
10) All Drivers and operators are in possession of valid
4) Risk Assessment design to work.
licence / competency certificate.
5) Work-in-charge and operatives aware of risk 11)
Plant & Equipment got valid third party certification.
involved and control measures to follow.
6) Prevention to stop sides collapse is on site 12)
Flagman / Signalman provided.
(battering / safe angle)
 The above precautions / requirements are in place.
  DFC 
Subcontractor Risk Assessment No. …………………….. Dated …………………… was
addressed to the team and work in-charge on (Date)……………….. , and they are fully aware of the same.

Project Manager / Engineer(Name): Signature:

Safety Officer(Name): Signature:

Section III
This Permit is valid till (Date): Time: Hrs.

Project Manager / Engineer H&S Officer

Name: Name:
Signature: Signature:

Section IV
This permit should be returned to the approving authority after completion of works signed by Site Engineer / Work In-
charge.

Name: Signature

Date: Time

NB: Drawing indicating proposed excavation to be attached to Excavation Permit.