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Excavation Permit: Project Name: - Name of Subcontractor/Company

This excavation permit document outlines the safety precautions and procedures for an excavation project. It requires information about the project name, subcontractor, protective systems used, purpose of excavation, dimensions, hazardous atmospheres, safety equipment, and a job hazard analysis. The permit also specifies that ladders must be within 25 feet, spoil piles at least 2 feet from the edge, utilities protected, confined space entry procedures followed if needed, inspections conducted, and workers trained on excavation hazards. Upon completion or suspension of work, both the subcontractor and permit issuer must sign off.

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Joey Stanley Guzman
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264 views2 pages

Excavation Permit: Project Name: - Name of Subcontractor/Company

This excavation permit document outlines the safety precautions and procedures for an excavation project. It requires information about the project name, subcontractor, protective systems used, purpose of excavation, dimensions, hazardous atmospheres, safety equipment, and a job hazard analysis. The permit also specifies that ladders must be within 25 feet, spoil piles at least 2 feet from the edge, utilities protected, confined space entry procedures followed if needed, inspections conducted, and workers trained on excavation hazards. Upon completion or suspension of work, both the subcontractor and permit issuer must sign off.

Uploaded by

Joey Stanley Guzman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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EXCAVATION PERMIT

HSE-EXP-006
Project Name : ______________________________ Name of Subcontractor/Company: _______________________
PROTECTIVE SYSTEM USED: PURPOSE:
TRENCH SLOPING SEWER GAS
WOOD SHORING OTHERS: DRAINAGE PIT
HAZARDOUS ATMOSPHERE EXIST: VISUAL TEST DONE:
LENGTH: WET:
YES_____ NO______
WIDTH: DRY: YES_____ NO______
HEIGHT: IF YES, USE CONFINED SPACE PERMIT SUBMERGED:
SCOPE OF WORK: SAFETY EQUIPMENTS:

SAFETY PRECAUTION
1.0 LADDER SHOULD BE INSTALLED WITHIN 25 FEET OF ALL WORKER (EQUAL OR MORE THAN 4 FEET)
2.0 SPOIL PILE/EXCAVATED MATERIALSSHOULD BE NOT LESS THAN 2 FEET FROM THE OF EXCAVATION AREA.
3.0 OTHER MATERIALS ARE PROTECTED FROM FALLING INTO THE TRENCH/EXCAVATION.
4.0 WORKERS EXPOSED TO VEHICULAR TRAFFIC SHOULD WEAR REFLECTORIZED VEST.
5.0 UTILITIES ANG STRUCTURES SHOULD BE PROTECTED.
6.0 CONFINED SPACE PERMIT SHOULD BE USED OF SEWER OR GAS LINES ARE EXPOSED.
7.0 PERIODIC INSPECTION SHOULD BE MADE.
8.0 WORKERS SHOULD BE TRAINED ON THE HAZARDS OF EXCAVATION AND TRENCH DIGGING.
Additional Safety Precautions:_________________________________________________________________________________
The Equipment and/or location where the work is to be done has been inspected and the work is safe to do? YES NO
JOB HAZARD ANALYSIS
STEPS TO COMPLETE THE JOB POTENTIAL HAZARD HAZARD CONTROL

CONTROL PERMIT NO: _____________________________ LEVEL/AREA OF WORK: ____________________ REQUESTED DATE AND TIME: ___________ /________
REQUESTED BY: APPROVE/NOTED BY: CHECKED BY: (To be checked at the workplace)

Project In Charge: _______________________ _______________________________ __________________________________

Permit Receiver: _______________________ TECI - Permit Issuer TECI - HSE Dept.


PERMIT CLOSE OUT
PERMIT CLOSE OUT - SUBCONTRACTOR ( PERMIT RECEIVER )
The subcontractor acknowledge that the activity has been completed/suspended and the area has been left in a safe and satisfactory condition
Name: _________________________________________ Signature: ______________________________ Time: _______________ Date: ________________
PERMIT CLOSE OUT - TECI ( PERMIT ISSUER )
The permit issuer acknowledge that the activity has been completed/suspended
Name: _________________________________________ Signature: ______________________________ Time: _______________ Date: ________________

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