EXCAVATION PERMIT

This Excavation Permit is required for any works involving hazardous excavations (manual or mechanical). This
includes but not limited to deep excavations or excavating near the proximity of important underground facilities.

Project Name: Permit No.

Specific Location: DATE OF ISSUE:

TIME OF ISSUE:

Work Description:

List of Equipment, Tools, Machinery to be used: NAME OF CONTRACTOR:

NAME / SIG. OF RESPONSIBLE SUPERVISOR:

NAME/SIG. OF MECHANICAL EXCAVATOR OPERATOR

NAME / SIG.OF BANKS MAN / FLAG MAN

SHIFT VALIDITY
Day Night Both

Required Precaution Checklist

Operators Requirements Checklist Y N Na Equipment Requirements Checklist Y N Na Field Inspection Checklist Y N Na

Correct Driving license Beacon lights operational No underground utility cables

Competency Certificates
HSE Orientation
Banks / Signal man
Safety Helmet
Safety Shoes
Proper uniform
Satisfactory eye sight
Health condition is ok
Overall condition acceptable:
Other Precautionary Measures:
Horn Operational
Reverse alarm operational
Pedal break operational
Hand break operational
Tires/crawl in good condition
Head and signal lights
Clutch, gear lever, steering
Mirrors in good condition
Fire Extinguisher
Cabins in good condition
Yes No Over all condition acceptable:
No underground water line
No underground gas line
No important structures nearby
No overhead power lines
Excavation will not obstruct traffic
Building foundations will be avoided
Over all condition acceptable: Yes No
Important Notice:
By accepting this work permit the receiver undertake to fully
Comply with the requirements and take full responsibility
Yes No Of the deviations / non compliance caused by him
EXPIRY DATE:

EXPIRY TIME:

Approved by:

Noted by:

Responsible Supervisor to read and sign the important

instruction at the back of the Work Permit

Unrestricted ENG20016-QAFM-007 Rev.0

 SLOPING METHOD IMPORTANT INSTRUCTIONS.
Figure 1
1. For any excavations greater than 1.25 meters deep,
3 FT
excavation protection system shall be used such as
shoring system, sloping or benching method. Please see
Figure 1,2,3 for you reference.

2. In open excavations, the angle repose shall not be more

than 40 degrees measured from the horizontal, unless the
Stability of excavation sides/soil is determined by Permit -
Issuer.
BENCHING METHOD
Figure 2 3. Means of access /egress shall be provided for excavations
or trenches that are more than 4 feet (.92 m) and in every
25 feet of horizontal travel.

4. For excavation activity that crosses vehicle access or major-

road network, No Objection Certificates (NOC) shall be
obtained from all concerned or relevant authorities.

5. Mechanical excavation near or over power cables, water line

or other important underground utilities is not allowed
SHORING METHOD unless otherwise performed by specialized contractor or
Figure 3 professional organization both approved by management.

6. Excavation below the foundation or footing of any buildings

utilities or facilities shall not be permitted unless a safe
support system is provided by professional engineer.

7. Excavated materials shall be placed 3 feet away from the

edge of excavation and shall not be accumulated more than
1.5 times of its base/distance.
EXCAVATION CROSS BRIDGE
Figure 4 8. Protective barriers and flashing warning signs shall be placed
In all excavations near sidewalks, pavements and streets.
fully screened hard barriers shall be placed in deep
excavation in public places. Please see figure 4.

9. All deep excavations along the side of the road shall be

supported by approved shoring system designed by
Professional engineer or specialized contractor.

10. Cross bridges with full railings on both sides shall be provided
as means of access in the excavation. In public or downtown
areas, railings shall be fully screen to prevent children / pets
from falling.

11. Diversion ditches or other suitable means shall be used to

to prevent surface water from entering the excavation.
ground water shall be removed by suitable pumps.
Unrestricted ENG20016-QAFM-007 Rev.0
 12. All deep excavations alongside the marina, water channel,
rivers, and sea is not allowed unless Risk Assessment and
Method Statement is signed by all concerned parties.
Read and Acknowledged by :
Name : __________________ Sign: _____________
Designation: _____________________________________
Company: _____________________________________

Unrestricted ENG20016-QAFM-007 Rev.0