HEALTH, SAFETY & ENVIRONMENTAL (HSE)

EXCAVATION PERMIT Form ID: NBHH-HSE-FM-001 Rev. No: 01 Date: 01-07-2024 Page 1 of 2

AL HUDAYRIAT ISLAND PDA INFRASTRUCTURE - INFRA 3A & 3B ABU DHABI

Location: Permit No:
This permit-to-work (PTW) is to be retained by the Work In-Charge/Work performer while work is in progress and must be
displayed in the working area. A copy of this PTW must be retained by the issuing authority. After completion of job Return the
signed, completed permit to Issuing Authority for the hand-back procedure.
1. WORK DESCRIPTION
Issue Date:
Work Description
Valid until:

Attached Proposed/Existing Utility Drawings (Must be the latest Issue and latest As-built) ☐YES ☐NO

Type of excavation: ☐Manual ☐Mechanical Type of soil

Type of Protection will provide: ☐Slopping ☐Benching ☐ Shoring Area (MM)

Details of Trial pit

Method Statement / RA No. Length (L)

Drawing No. / Rev. No. Width (W)

INR Request Ref No: Depth (D)

Type of Equipment Used: Equipment Condition

Activity Perform by ☐NBHH ☐Sub-Contractor If subcontractor performing activity please provide company name:

Sub-Con Engineer Name Phone No. Sign:

2. CABLE AVOIDANCE TOOL SCANNING

Is Cable Avoidance Tool (CAT) scanning is required? ☐YES ☐No (If YES Please fill the below details)
MAKE/MODEL SERIAL NUMBER CALIBRATION EXPIRY DATE SCANNED DATE: AUTHORIZED PERSON WHO SCANNED FROM NBHH SURVEY DEPARTMENT:

Name: Sign & Date

(I confirm and sign above that area has been scanned and result is mentioned as per Sec-4 of this permit)
Remarks After
Scanning:
ALL the services that are known or supposed to exist within 3 meter of designated work area must be identified and their locations confirmed
1
by CAT scanning and Trial Pits by manual digging only. Trial Pits Must be undertaken prior to any mechanical excavation commencing.
Where service drawings indicate services, which cannot be located using CAT equipment the Authorized Engineer must seek advice on how to
2
PROVE THAT NO CABLES/WATER LINES are present prior to excavations being carried out!
3. RESULTS OF SURVEY, CAT SCANNING (Tick the services found)
Electrical cables underground Electrical OHL Telecommunication Street Lighting

Water mains Sewers / Drains Gas mains (below 2 bar) Gas mains (above 2 bar)

Other services
Note: - I confirm that above stated cat scanning is done correctly. I witnessed and I Name:
confirm the results marked above are correct permit applicant (site engineer) / Sign:
subcontractor site engineer - for this activity Phone No:
Note: Mechanical Excavation must not be used within the above safe distances unless an approved safe system of work is in place
Details of all the services identified during the CAT scan and trial holes must be annotated on the relevant drawings. Trial holes must be uniquely
numbered with location & dimensions clearly identified (use additional sheet as necessary)
4. SAFETY PRECAUTIONS
Hard Barriers Traffic diversion required Existing Utilities Marked & Utility markers /chamber checked
Excavation Sign Safe Access Provided Spoils kept away from the edge of excavation minimum 2Mtrs.
If underground utilities are identified then no mechanical excavation
Flashlights Soft Barriers / Warning Tape
within 3 Mtr. NOI(Notice of Intent) to be submitted
Dewatering System Mechanical Equipment Vehicle access routes are protected and identified.
.
 HEALTH, SAFETY & ENVIRONMENTAL (HSE)
EXCAVATION PERMIT Form ID: NBHH-HSE-FM-001 Rev. No: 01 Date: 01-07-2024 Page 2 of 2

5. PERMIT REQUEST (SITE ENGINEER)

Name of Work In-Charge: Nominated Work Performer Name:
I have personally viewed the area, assessed the hazards, and shall make sure that necessary Designation: Date & Sign:
precautions are implemented for this work. I nominated above mentioned foreman as work performer
and have made him and his team understood the requirements of this PTW and ensure their adherence
to it.
6. PERMIT AUTHORIZATION (CONSTRUCTION MANAGER)
I, as an issuing authority declare that the above work has been discussed with the person(s) in charge of Designation: Date & Sign:
the work, the risk assessment / method statement has been reviewed and all safety precautions /
actions required are in place have been inspected by myself in accordance with this PTW requirements.
7. HSE VERIFICATION
HSE Comments/Recommendations: Name & Designation: Date & Sign:

8. DAILY REVALIDATION
Daily Inspection Revalidation Time & Sign By
Date
(Excavation Checklist must attach daily) Engineer Foreman Safety Officer
Dt: Excavation Checklist Attached? ☐ Yes ☐ No
HSE Comment:
Day - 2

Dt: Excavation Checklist Attached? ☐ Yes ☐ No

HSE Comment:
Day – 3

Dt: Excavation Checklist Attached? ☐ Yes ☐ No

Day – 4 HSE Comment:

Dt: Excavation Checklist Attached? ☐ Yes ☐ No

Day – 5 HSE Comment:

Dt: Excavation Checklist Attached? ☐ Yes ☐ No

Day – 6 HSE Comment:

Dt: Excavation Checklist Attached? ☐ Yes ☐ No

Day – 7 HSE Comment:

9. WORK COMPLETION / CANCELLATION.

☐ All works Completed on this PTW, all persons, materials and equipment involved have been withdrawn and site left clean, tidy
and safe.
☐ All works on this PTW has been suspended and PTW cancelled by HSE Responsible.
Work In-Charge Name: Sign: Date & Time:
Authorized Person: Name & Designation: Date & Sign:
The work covered by this PTW is complete and the area has been left safe, clean,
and tidy.

10. PERMIT CLOSING ATTACHMENT

☐ INR – Setting out ☐ Approved Drawing ☐ Utility SCAN Report
☐ Accident/Incident Report (if Any) ☐Excavation Checklists ☐ Other
IN CASE OF EMERGENCY PLEASE CALL PROJECT EMERGENCY NUMBER - +971 50 728 8240
.