Guides:
Sample Permits to Work:
Complies with NFPA 51B - Standard for Fire Prevention During Welding, Cutting and Other Hot Work
EXCAVATION
Issuing Permits - The issue of permits is strictly controlled, permits can only be issued by authorised personnel.
PERMIT NUMBER:
CONTRACTOR (Company):
CONTRACTOR (Employee Name):
LOCATION OF WORK (Exact):
DESCRIPTION OF WORK:
SPECIAL INSTRUCTIONS:
Which of the following hazards are associated with this work:
Sub-surface utilities located & marked
Vehicle Movement
Lack of Space
Overhead Electric Cables
Unguarded Edges
Unsecured Ladders
Falling Objects / Debris
Uneven Floor Surfaces
Manual Handling of Loads
Wet Conditions
OTHER HAZARDS NOT LISTED ABOVE:
Approximate height work will be carried out:
Has the area been sectioned off?
Is adequate signage provided?
I declare that the above has been made known to the competent person in charge of the work and consider the above mentioned area to be safe for the competent person to commence work.
Signed:
Date:
Permit Controller:
Time:
Acceptance by competent person prior to commencement
I understand the work that is to be carried out and the safety precautions that are necessary to complete the work safely as outlined in the appropriate method statement and risk assessments. If conditions are such that the method statement and risk assessments become invalid it is my responsibility to stop work immediately and notify the person who authorised this permit to work.
Signed:
Date:
Competent Person:
Time:
Continuation of Work
I hereby authorise the work specified above to continue until the time stated below and that I have checked the safety arrangements and confirm that they remain adequate.
Permit has been extended to:
am / pm
Signed:
Date:
Permit Controller:
Time:
Permit Cancellation
This permit is cancelled. The work is / is not complete. Safety precautions have / have not been removed.
Signed:
Date:
Permit Controller:
Time:
Completion of Work
Final check by Contractor / Employee
I declare that the work described above is complete all work equipment, persons and materials under my control have been withdrawn. All safeguards have been reinstated and the work area returned to a safe status and service.
Signed:
Date:
Competent Person:
Time:
Completion of Permit - Permit Controller
I declare that the permit is now closed and I have received copies of the permit back from the Competent Person. The area has been inspected and is free from risk and all fire protection systems have been reinstated to their normal operating status.
Signed:
Date:
Permit Controller:
Time:
GENERAL PRECAUTIONS
1. General Inspection of Job Site
a. Excavations, adjacent areas and protective systems inspected daily by a competent person before the start of work.
b. Surface encumbrances removed or supported.
c. Personnel protected from loose rock or soil that could pose a hazard by falling or rolling into excavation.
d. Hard hats worn by all personnel.
e. Spoils, materials, and equipment set back at least 1metre, (3 feet) from the edge of the excavation.
f. Competent person has the authority to remove personnel from the excavation immediately.
g. Barriers provided at all remotely located excavations, wells, pits, shafts etc.
h. Walkways and bridges over excavations 1.0m (3ft)or more in depth are equipped with standard guardrails and toe boards.
i. Warning vests or other highly visible clothing are provided and worn by all personnel.
j. Personnel are required to stand away from vehicles being loaded and unloaded.
k. Warning system established and utilised when mobile equipment is operating near the edge of the excavation.
l. Personnel prohibited from going under suspended loads.
m. Personnel prohibited from working on the faces of slopes or benched excavations above other personnel.
2. Utilities:
a. Utility companies contacted and/or utilities located.
b. Exact location of utilities marked.
c. Underground installations protected, supported, or removed when excavation is open.
3. Means of Access and Egress:
a. Lateral travel to means of egress no greater than 8meters (24feet) in excavations 1.5meters (4 feet) or more in depth.
b. Ladders used in excavations secured and extended 1m (3 feet) above the edge of the trench.
c. Structural ramps used by personnel designed by a competent person.
d. Structural ramps used for equipment designed by a registered professional engineer (RPE).
e. Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with a non-slip surface.
f. Personnel protected from cave-ins when entering or exiting the excavation.
4. Wet Conditions:
a. Precautions taken to protect personnel from the accumulation of water.
b. Water removal equipment monitored by a competent person.
c. Surface water or runoff diverted or controlled to prevent accumulation in the excavation.
d. Inspections are made after every rainstorm or other hazard increasing occurrence.
5. Hazardous Atmosphere
a. Atmosphere within the excavation tested where there is a reasonable possibility of an oxygen deficiency, combustible or other harmful contaminant exposing personnel to a hazard.
b. Adequate precautions taken to protect personnel from exposure to an atmosphere containing less than 19.5% of oxygen and/or to other hazardous atmospheres.
c. Ventilation provided to prevent personnel exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas.
d. Testing conducted often to ensure that the atmosphere remains safe.
e. Emergency equipment, such as breathing apparatus, safety harness and lifeline, and/pr basket stretcher readily available where hazardous atmospheres could or do exist.
f. Personnel trained to use personal protective and other rescue equipment.
g. Safety harness and lifeline used and lifeline used and individually attended when entering bell bottom or oether deep confined excavations.
6. Support Systems:
a. Materials and / or equipment of support systems selected based on soil analysis, trench depth and expected loads.
b. Materials and equipment used for protective systems inspected and in good condition.
c. Materials and equipment not in good condition have been removed from service.
d. Damaged materials and equipment used for protective systems inspected by a registered professional engineer (RPE) after repairs and before being placed back into service.
e. Protective systems installed without exposing personnel to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment.
f. Members of support system securely fastened to prevent failure.
g. Support systems provided to ensure stability of adjacent structures, buildings, roadways, sidewalks etc.
h. Excavations below the level of the base of footing supported, approved by an RPE.
i. Removal of support systems progresses from the bottom and members are released slowly as to note any indication of possible failure.
j. Backfilling progresses with removal of support system.
k. Excavation of material to a level no greater than 0.5meters (2 feet) below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth.
l. Shield system placed to prevent lateral movement.
m. Personnel are prohibited from remaining in the shield system during vertical movement.
