ETIHAD RAIL – 2F1

Permit to Excavate (Including Trenching and Piling)

EACH EXCAVATION AREA REQUIRES A UNIQUE PERMIT- NOT TRANSFERABLE
Valid from date: To Date: Project Area/zone: Permit Number:
Valid from Time To Time:
DESCRIPTION OF WORK IS TO BE DONE:

Depth Length Width

SECTION A – TO BE COMPLETED BY DESIGNATED PERSONS IN NUMERICAL ORDER: DO NOT SIGN IF PREVIOUS STEP INCOMPLETE
“I have personally inspected the site conditions and confirm safe conditions for work have been fulfilled”
STEP 1: SURVEYING DEPT. STEP 2: LOGISTICS/ENGINEERING STEP 3: MANDATORY CAT SCAN - BY COMPETENT PERSON
FOLLOWING IS COMPLETE
EXISTING SERVICES DRAWING IS AVAILABLE ➢ COMBINED SERVICES DRAWING CAT SCAN COMPLETED, ARE SERVICES PRESENT; YES NO (CIRCLE)
➢ NOC ISSUED By LOCAL AUTHORITY e.g. RTA / IF YES – MARK ON DRAWING AND DESCRIBE
ANY ADDITIONAL INFORMATION: DEWA / DM
IF SERVICES DEAD – STATE COMMUNICATED MACHINE WORKING DISTANCE
NOC N0..............................................................
IS ‘SECTION C’ COMPLETION REQUIRED: (Circle) YES NO
DATE OF ISSUE:
PRINT NAME: PRINT NAME:
PRINT NAME:
Sign and date: Sign and date:
Sign and date:

SECTION B – TO BE COMPLETED BY EXCAVATION/PILING SUPERVISOR (competent person) VALID 7 DAYS (NO WORK IN 7 DAYS – NEW PERMIT)
BASIC SAFETY CHECKLIST - MANDATORY
This Permit to Excavate / Pile registered and
complete
Relevant NOC and RA available at work area
Competent Supervision and Banks-man utilized
Nightshift - Excavation Illumination to standards
Competent Personnel to undertake TBT (recorded)
Suitable access and egress to excavation established
Emergency procedure known and instructed
Certificated and Trained plant operators to be used
Piling Rig positional drawing provided
Others (State)
YES EXCAVATION/PILING CHECKLIST Yes No
NO MECHANICAL DIGGING OF EXCAVATION WITHOUT CAT SCAN UNDERTAKEN
GAS MONITORING BEING UNDERTAKEN BY AUTHOURISED GAS TESTER
Underground obstructions (not services) are marked, identified, and communicated
Up to Date Service Drawings (Mandatory)
Any Underground services marked, Identified, and communicated
Any Electrical cables/conduits / Gas /Oil / lines present (complete section C of this permit)
If any communication/ IT cables, water, or sewer lines: State which:
Is an additional Confined Space Permit required for the work?
All excavations to 2F1JV/HSE/MAS/00246, system to be used (benching /shoring
/bracing):

SECTION C – TO BE COMPLETED IF ANY LIVE CABLES / GAS / PIPES OTHER RISK PRESENT VALID FOR 7 DAYS ONLY.
Excavation Commencement: ACCEPT
A. Mechanical Excavation: B. Manual/ Hand Tools Excavation: C. Gas Monitoring (H2S Reading) ________ PPM
1. Can the underground service be isolated for the duration of the works – If YES 2F1JV Lock-out / Tag-out system to be utilized
2. At all times during the task a competent supervisor will be allocated and be present at the immediate area of the excavation
3. Machine Operator has been instructed to only excavate within 1.5 metres in any direction of any exposed, identified or marked cable or pipe.
If this is not practicable, state agreed working distance. .......................metres
4. All underground services shall be treated as live unless stated in Section A of this permit.
2F1JV HSE HOLD POINT
5. All underground services will be located and marked immediately by surveyors, prior to any excavation or piling works. (Confirm service marked)
Services exposed by hand digging only. Sign:
SHIFT DAY 1 NIGHT DAY 2 NIGHT DAY 3 NIGHT DAY 4 NIGHT DAY 5 NIGHT DAY 6 NIGHT DAY 7 NIGHT
SIGN ON
SIGN OFF
THE AREA WILL BE INSPECTED BY THE PERMIT APPLICANT OR HIS DESIGNATE BEFORE RESIGNING THE PERMIT AT THE START OF THE NEXT SHIFT

SUPERVISOR STATEMENT OF COMPLIANCE:

“I confirm all control measures detailed above are in place and before works commence this Permit to Work will be shown and communicated to all Competent Persons associated
with the task. Also, on any damage to any known / undetected service I will cease work and immediately report to management”
Signature Supervisor: Print Name: Date:
SECTION D – TO BE COMPLETED BY AREA CONSTRUCTION MANAGER
NOTE: CONST. MANAGER SHALL ONLY SIGN AUTHORIZATION IF:
1. CAT SCAN HAS BEEN UNDERTAKEN AND ANY CABLES MARKED. SIGNED AREA CONSTRUCTION MANAGER:
1. 2. ALL DOCUMENTATION COMPLETE (JSEA, SERVICE DRAWING ETC);
2. 3. ALL CONTROLS STATED IN RISK ASSESSMENT ARE IN PLACE AND FORM ATTACHED. Date:
3. 4. ALL SIGNATURES ABOVE ARE SIGNED BY DESIGNATED PERSONS

SECTION E – TO BE COMPLETED BY HSE DEPT:

2F1JV SAFETY REPRESENTATIVE – ONLY SIGN OFF PERMIT IF: SUB-CONTRACTOR SAFETY REPRESENTATIVE:
1. ALL SECTIONS COMPLETED. EXCAVATION AREA CHECKED AND PASSED OFF
2. SECTION B - SAFETY CHECKLIST HAS BEEN COMPLETED.
3. EXCAVATION AREA CHECKED FOR SAFETY CHECKLIST COMPLIANCE. PRINT NAME:
4. SUPERVISOR AWARE OF HAND DIG HOLD POINT REQUIREMENTS.
SIGN: DATE:
PRINT NAME:
SIGN: DATE:
SECTION F – PERMIT CLOSE OUT – TO BE COMPLETED BY PERMIT APPLICANT
I hereby declare that the work detailed above has been completed / suspended and that all persons under my charge have been withdrawn from the specified work area and
instructed that this Permit-to-work has now been cancelled and that the area has been left in a safe condition. All existing warning tape has been replaced as required.
SIGNATURE PERMIT APPLICANT: Print Name: Date:

SIGNED OFF - AREA AUTHORITY: Print Name: Date:

 Permit to Excavate (Including Trenching and Piling)

Armed Forces Officer Club and Hotel / P1122

H2S Monitoring
EQUIPMENT:
Date:

Exposure Secondary
SN. Timings Location Work area Remarks
Area Barrier
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