Clearance for Excavation (to be issued along with Hot work for Excavation Job)

Date & Time :

A. (i) Name of the Installation :
(ii) Name of Installation Manager :
(iii) Name of the supervisor of Contractor :
(iv) Name of supervisor of OIL :
B. Details of excavation:
Length…………………………..M, Applicable/NA Yes/No Sl No Date
Width……………………………M, Hot work
Depth……………………………M Applicable
Permit
Mode of excavation: Mechanized/Manual Electrical
No. of workers engaged………………No. Permit
(if issued)
C. Checklist for clearance
Sl Description Yes No Not Applicable Remarks
no.
1 Stability of the ground
2 Provision for at least two entries and exit with escape ladder
beyond 1.5m
3 Adequate PPEs provided to all workmen
4 Provision for suitable shoring (A beam or timber that is
propped against a structure to provide support) and
strutting ( Brace consisting of a bar or rod used to resist
longitudinal compression)
5 Whether soil heaps are away from the edge at least 2mtr or
half of the depth whichever is more
6 Whether arrangement is made for vehicles not to operate
the close to excavation area (maintain at least 2 mtrs
distance)
7 Whether slop is maintained not less than 1:1 and suitable
bench of 0.5 mtrs width at every 1.5 mtr depth
8 Sufficient lighting in the night
9 Provision for dewatering arrangement
10 Provision for guard rails/ barricade with warning signal
11 Whether the excavation will not affect adjoining buildings,
structures or roadways
12 Whether Gas ,water, electrical and other public utilities are
shut off or disconnected, if necessary
13 The position of culvert/bridges, temporary roads and spoil
heaps
14 Presence of underground pipes, cable conductors, etc.
1. Underground Power Cable
2. Underground Telecommunication Cable
3. Underground Firewater Line
4. Underground Oil/Sewer Line, Drinking water line,
Above ground Open drain
5. Underground Computer Cable
6.Underground Product Line, Utility Line
7. Underground Instrument Cable
8. Underground Cathodic Protection Cable
Note: The above clearance is not exhaustive and may be reviewed as and when required
 Joint Site Visit for Excavation clearance
Date :

Location :

Sl. Department Name & Designation Remarks Signature

No. (with Mobile Number)

1 E&C

2 T&I

3 PLM

4 PLP

5 Operations

6 CIVIL