Excavation Permit to Work
Author: Novade Solutions
Ensures safe excavation by managing risks like cave-ins and utility strikes. The workflow includes approvals, revocation, rejection, and extensions.
Excavation Permit to Work
General Information
*Work Location Photo
Items to check
Select (✓) to indicate OK; (✘) to indicate not OK; (N/A) for conditions not required.
Workers have been briefed on the risk assessment, safe work procedures, and adequately trained according to the Method Statement.
Attach Risk Assessment
Area has been cordoned off with hazard lights and warning signage displayed prominently.
Site has been checked by a licensed cable detection worker (LCDW) before excavation.
Gas, electric, water, and utility lines/energy sources have been isolated, relocated, and protected.
Adequate ventilation is provided.
Shoring and bracing or PE-designed cut slopes provided for trench depth greater than 1.5m but less than 4m.
Safe means of access and egress are provided for the excavated area.
No incompatible works are taking place in the surroundings.
Excavator Checklist
*Operator is fully acquainted with the Operator's Manual before operating.
*Windows are undamaged and clean.
*Electric horn is functional.
*Rearview mirror is undamaged and intact.
*Swing flashers are intact and effective.
*Safety device lock is effective.
*Multi-display monitor check is satisfactory.
*No other damaged or broken parts.
Remarks
Extension
*Is an extension required for this PTW?
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Excavation Permit to Work
General Information
*Work Location Photo
Items to check
Select (✓) to indicate OK; (✘) to indicate not OK; (N/A) for conditions not required.
Workers have been briefed on the risk assessment, safe work procedures, and adequately trained according to the Method Statement.
Attach Risk Assessment
Area has been cordoned off with hazard lights and warning signage displayed prominently.
Site has been checked by a licensed cable detection worker (LCDW) before excavation.
Gas, electric, water, and utility lines/energy sources have been isolated, relocated, and protected.
Adequate ventilation is provided.
Shoring and bracing or PE-designed cut slopes provided for trench depth greater than 1.5m but less than 4m.
Safe means of access and egress are provided for the excavated area.
No incompatible works are taking place in the surroundings.
Excavator Checklist
*Operator is fully acquainted with the Operator's Manual before operating.
*Windows are undamaged and clean.
*Electric horn is functional.
*Rearview mirror is undamaged and intact.
*Swing flashers are intact and effective.
*Safety device lock is effective.
*Multi-display monitor check is satisfactory.
*No other damaged or broken parts.
Remarks
Extension
*Is an extension required for this PTW?