PERMIT TO EXCAVATE

Permit No.: Project Title SHARJAH WATERFRONT CITY

PERMIT REQUIRED FOR Excavation LOCATION: SECTOR / 2

Section – I CONTACT DETAILS

Task Supervisor/Foreman
Engineer Responsible
Safety Officer on Site
Section – II
PERMIT ISSUE DETAILS
PERMIT EXPIRY DETAILS
Chima Elvis
PERMIT VALIDATIONS
Date ____________________
Date ____________________
Contact Number
Contact Number
Contact Number
THIS PERMIT IS VALID FOR MAXIMUM
Time ________________ OF 12 HOURS ONLY. PERMIT SHOULD
BE RENEWED IF SHIFT CHANGES.
NO EXTENSION WILL BE GIVEN ON THIS
Time ________________ PERMIT

THIS PERMIT IS ONLY TO BE USED BY THE PERSONS TO WHOM IT IS ISSUED. ON COMPLETION OF THE TASK OR ON EXPIRY THE
PERMIT IS TO BE RETURNED TO THE ISSUER FOR CANCELATION

Section – III REQUIREMENTS (Work May not commence if one of the following is not complied with)
Y/
 for YES and X for No Y/N NA  for YES and X for No N
NA

Have The Operatives for the task been

Is the Work Area Clearly Defined? Have the briefed on the Risk Assessment. Is this
A F Signed for?)
latest drawings been Consulted?

Have barriers for the proposed excavation

If using an equipment for excavation, does it been made available?
B G
have a valid 3rd party certificate?

Have signboards and flashing lights been

Does the operator have a valid competency provided?
C H
certificate?

Have All necessary Trial Trenches been Are banks men provided for moving
D I
Excavated? machinery?
Has a Risk Assessment Been Completed for Does the excavation require additional
E J
the task? specialist trench support?

Section - IV Briefing / Tool Box Talks Attendance

NAME SIGN NAME SIGN
1 7
2 8
3 9
4 10
5 11
6 12
DECLARATIONS COMMENTS BY HSE

We ensure that the precautions checked and/or written above have been
taken and will be followed throughout the duration of the job.
Permit Issuer (Engineer):
Name /Sign………………………………..…….. Date/Time:…………………..
Permit must be closed after completion of the excavation or at the
end of the shift and should be submitted to HSE office.
Permit Receiver (Task Supervisor / Foreman):
Closed / Cancelled by:……………………………... Time:
Name /Sign……………………………… ………Date/Time…………………… ……………. Reason:…………………………
PERMIT COPY DISTRIBUTION (tick appropriate boxes):
Project Construction Project
HSE Personnel (HP) Job area
Manager(PM) Manager(CM) Engineer