Permit No.

& Date
EXCAVATION WORK PERMIT
Project & Unit: Emergency Contact Nos
HSEP:12-F05 Agency:

Exact Location of Work: _________________________________________________________________________________________________

Nature / Description of Work:
Duration of Work Execution *: From Date: to Date: ____Daily from ______________ hrs. to ___________hrs.
Name of Agency Performing the Work:
Name of Agency’s Site Engineer (Permit Requesting Authority): Sign:
Name of Agency’s Package In-charge: Sign: Date:
The above described work will be done under all the safety precautions mentioned on this permit to work as under during the currency of the Permit.
Not required /
No. Item Yes Remarks
1. Precautions taken for Underground Electrical Cable
2. Precautions taken for Under / Above ground sewer/Drinking Water Line
3. Precautions taken for Underground Telecommunication Line
4. Precautions taken for Underground Product/Utility Line
5. Precautions taken for Underground Fire Water Line
6. Shoring / Shuttering / Sheet piling done to prevent collapse of excavation walls. Strength of Excavation wall
ensured at all times
7. Hard Barricading & Edge Protection provided
8. Separate Safe Access for Man and Vehicle
9. Lighting arrangement
10. Banks Man Provided
11. Required basic PPEs provided
12. Slope Cutting/Benching Maintained
13. Excavated soil / Construction Material / equipment kept away from the edge.
14. Emergency response team & Medical Facilities available.
15. Work hazards are identified, controlled and communicated to the worker.
16. Method Statements/ Job Safety Analyses attached:

17. Other:
(To be printed on both sides of an A4 Sheet)

18. List of Other Permits Required for the Activity (Attached):

The conditions mentioned in the above checklist are sufficient for safe completion of this activity. These have been checked and found complied before issuing the
Permit, and shall be monitored and ensured throughout the currency of this Permit.

A. Permit Requester/ Receiver (Agency):

Site Engineer: Site HSE Officer:
Signature: Signature:
Name: Designation: Name: Designation:
B. Permit Issuer (BHEL):
Site HSE Officer/ Authorized Representative: Site Engineer/ Authorized Representative:
Signature: Signature:
Name: Designation: Name: Designation:
C. Package-in-charge (BHEL):
Signature:
Name: Designation:
(* Permit valid for 14 days as per overleaf format)
Original: Permittee 2 nd Copy: Agency Deptt. HOS 3rd Copy: BHEL Site HSE

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Bharat Heavy Electricals Limited, Power Sector
 Permit No. & Date:
__________________________
Daily Work Area Condition Endorsement _
Remarks (if any) & Signature with Date & Time
Day Date Agency Site Engineer Agency HSE Officer BHEL Site Engineer * BHEL HSE Officer *
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Permit Extension Beyond Initially Requested Hours

Extension Period Signature with Date & Time
Sl. No. From……. To…… Remarks Agency Site Agency HSE BHEL Site Engineer * BHEL HSE Officer*
(Date, Time) (Date, Time) Engineer Officer
1
2
3
4
5
6
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Permit Closure After Work Completion
Permit is here by returned after completing the job, ensuring safe removal of men and material and proper housekeeping of the Area.

Reason for Closure: Job complete Permit Validity Over

Agency
Site Engineer Site HSE Officer
Signature: Signature:
Name: Name:
BHEL
Verified as above and Permit is Closed
In case job not complete, New Permit No. Issued:
Site HSE Officer* Site Engineer*
Signature: Signature:
Name: Name:
(* or authorized representative duly concurred by Region HSE)

Bharat Heavy Electricals Limited, Power Sector Page 2 of 2