VELLAPALLY

CONSTRUCTIONS

Permit Serial Number:

EXCAVATION CLEARANCE PERMIT

A. Applicability

(i) Existence of service lines and utilities (ii) In the proximity of existing structures, buildings,
foundations, installations like gas, electrical service stations etc. (iii) in case of green field for
excavation beyond 1.5m (iv) any other conditions which may result in serious hazardous
consequences.

Site/Office :
Sub-Contractor Details (If any) :
Date :

Verification by respective in charge of Electrical/Engineering/Telecommunication Services

1. Whether underground utilities/cable present in the area to be excavated - Yes /No

If yes provide details of underground
utilities……………………………………………………………
2. The utilities are isolated/de-energized and safe for proceeding with excavation
3. Additional precaution to be implemented during excavation
………………………………………….

S.
N Description Yes No N/A
o
Have utility companies been notified of proposed excavation
1
work?
Are all tools, equipment, and shoring materials readily available
2
prior to job start up?
Are overhead utility lines noted and precautions taken to avoid
3
contact with the equipment?
Is the soil pile at least two meter from the edge of the
4
excavation?
Is the excavation inspected regularly or more frequently when
5
climate conditions could affect the soil?
6 Are barricades, stop logs, properly placed?
Are excavations 1.5m or deeper correctly sloped, benched,
7
shored?
Is a step or other means of egress provided in excavations
8
deeper than1.5 m?
Are shoring and shielding systems inspected visually daily by a
9
competent person?
10 Is there any object liable to fall in the excavation?

Other Observations

Verification by EHS Personnel

I have verified the safety arrangements and found satisfactory to carry out further works
Name & Signature of verifying EHS Personnel