Type of Permit Required Additional PPE Requirements
Special tools or equipments required (Please List) Cold Work Permit Excavation Certificate Hot Work Permit Category 1. Dust Mask 1. Inspected Power/Hand tools 2. Reflecting Vest 2. Standby Vehicle 3. Full body harness 4. Gloves 5. Safety Shoes 6. Safety Helmet 7. Coverall Job Safety Analysis
Approved By: Signature: Date:
Report Number Incident Summary
Activity Assessment Form
Manual Excavation for Residual Task / Activity Risk Responsi Hazard Hazard Effect Control Measures Risk Description Rating bility Rating Follow PPL PTW/excavation certificate Identify all utilities underground and mark them on ground. Area clearance from relevant PPL authorities. Asset Damage Presence of PPL representative at start of excavation. Gasco Underground 3B Safety sign boards for awareness. 1B Cables/services Plant trip JSA meeting and Tool Box Talk prior to start of work Manual Excavation
Use Dust Mask
Dust / Excavated Personnel injury 2B Dump excavated soil to a safe distance, watering the area.(1.5 m) 1B material Job Safety Analysis
Backfilling / JSA meeting and Tool Box Talk
Reinstatement Improper backfilling Personnel injury 2B Proper backfilling in marked area 1B Gasco of area
Personnel injury Use dust mask
dust 2B 1B
Periodic rest at work site
Sufficient drink at work site Extreme weather Personnel injury condition B2 Proper rest or shelter place at site 1A Tool talk included precautions to stress and fatigue Gasco Housekeeping JSA meeting and Tool Box Talk Proper housekeeping. Environmental Non degradable Proper disposal of waste as per standards of PPL waste damage 2B 1B After backfilling spray water in order to settle down the soil Provide waste drums for waste segregation Job Safety Analysis