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Excavation Work Permit Rev-02

The document outlines an Excavation Work Permit, detailing safety checks and requirements for excavation activities. It includes sections for permit initiation, safety declarations, and closure, ensuring compliance with safety protocols. The permit must be signed by various personnel, including the permit initiator, safety officer, and client representative.

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Susobhan Mondal
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0% found this document useful (0 votes)
25 views1 page

Excavation Work Permit Rev-02

The document outlines an Excavation Work Permit, detailing safety checks and requirements for excavation activities. It includes sections for permit initiation, safety declarations, and closure, ensuring compliance with safety protocols. The permit must be signed by various personnel, including the permit initiator, safety officer, and client representative.

Uploaded by

Susobhan Mondal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Excavation Work Permit

Permit No.: _____________________________ Date & Time: _________________


Project: ____________________________________________________________________________ Location: ______________________
Job Description: _____________________________________________________________________ Work Performed by: ____________
Permit Valid: Time from (Time to) ______________________________________
Section-I
SL No Description Yes/ No SL No Description Yes/ No
Underground utilities have been checked as applicable. Electrical /
1 Mechanical 11 Emergency plan is available and reviewed.
isolations are required
Method statement and Risk assessment is made Emergency Contact number is communicated and
2 12
for activity posted at location
Employees are safety inducted and trained prior Risk controls measures for fall prevention,
3 13
to activity commencement. collapse of excavation in place
Employees are in possession of the PPE Water/Oral dehydrate drinks is available
4 14
specified for the job as risk assessed. (Heat Stress)
Operatives are trained, competent the Soil bank piled no closer than 3 feet of
5 15
specific activity mouth of trench / excavation
Driver/ Operator must have valid driving license/ operating Excavated pit/ trench protection system, barricades 3ft
6 16
certificate from the edge, signage are in place.
If manual excavation are commencing, the operatives
Adjacent structures if present the impact is checked and
7 must have isolated tools and non 17
risk controls are in place.
conducive PPE's
Excavation side must be slope or step cutting to
8 Competent supervision is available at all time. 18
prevent soil collapse
Safe access and exit route to and from excavation is 1st use of equipment use the relevant checklist and
9 provided at diagonally 19 attached with the permit, prior commence
opposite ends. mechanical excavation
10 Permit is posted at the activity location. 20 Other:-
Section-II (Permit initiator /Requester)
Declaration: -
a. All the above safety precautions have been put in place, based method statement and HIRA/JSA verified by me on ground personally.
b. I shall ensure all the necessary precautions, till end of the work & I shall take full responsibility in case of any deviations or lapses noticed on site.
Details Name Signature Date & Time

Permit Initiator/ Requester


Engineer/ Supervisor:

Checked & Conformed by


Safety Officer: Comments if Any:

Reviewed & Approved by


PMC/ Client:
Section-III (Permit Closure)
Declaration: -
The above-mentioned job has been completed in satisfactorily. Date…………………………………. & Time..................................this permit is closed.
Details Name Signature Date & Time

Permit Initiator/ Requester


Engineer/ Supervisor

Checked & Conformed by


Safety Officer

Reviewed & Approved by


PMC/ Client

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