PERMIT TO DIG/ EXCAVATION PERMIT CONTRACT No.

PERMIT No.

PROJECT/ SITE

ALL WORK UNDER THIS PERMIT IS VALID FOR A SINGLE ACTIVITY AND PER SHIFT
REQUESTED BY (Supervisor) DATE & TIME DURATION

CONTRACTOR
SPECIFIC WORK LOCATION

DESCRIPTION OF WORK &

HAZARDS (Must include, or attached,
dimension of excavation, service
detection method, design drawing
reference, hold points, etc.)

PLANT & EQUIPMENT

IDENTIFICATION. E.g. Excavator,
hand tools, Service scanner etc.
Mention ID numbers.

Requirement Yes No N/A Requirement Yes No N/A

Design provided (if depth is in excess of 1.25m) Exclusion zone & traffic management is been established.
Atmospheric testing is undertaken (where excavations are in the vicinity Plants & machinery have valid certificates issued by approved DM
of a confined space) bodies.

PERMIT TO DIG REQUIREMENT Plant operators have valid licence & DM approved operator
Service identified & marked
(Must be completed by Supervisor and assessment.
verified on site by Permit Authoriser) Location of new services recorded & marked. Plant & machinery have been inspected to be fit for purpose.
NOC’s is obtained where work is to be undertaken within 5 metres of
Plant operators are physically & medically fit.
any live DEWA service.
Any other Permit required? E.g. Hot work Operatives briefed on MSRA, activity and PTW requirement.

Signages, edge protection & lighting is installed.

1st Test Readings 2nd Test Readings 3rd Test Readings

ATMOSPHERIC MONITORING
(where excavations are in the vicinity of Time: Time: Time:
Permissible Entry Levels Signature: Signature: Signature:
a confined space E.g. live sewers,
where plant and machinery are nearby
Oxygen 19.5% - 23.5%
or in areas where air flow is restricted.
(Must be carried out by trained Combustible/ Flammable gas (E.g. Hydrogen) Less than 10%
person using a calibrated gas tester)
Other toxic gases

ISSUE

_______________________
Signature, Date & Time
I ….Supervisor …………………………(Permit requestor) confirm that this Permit to Dig requirement have been checked and recorded at work location.
I will ensure all operatives are briefed on Permit to Work requirements and the activity.

_______________________
Signature, Date & Time
I ……..Site/ Construction/ Project Manager …. (PTW Authoriser) confirm to authorise the Permit to Dig as detailed in this Permit.
I confirm that I have physically checked work location and all Permit to Dig conditions is satisfactory.

HAND-BACK/ CLOSE OUT (Must be completed by Supervisor/ Permit requestor and returned to Permit Coordinator)

Work is completed at (Time & Date): ………………….

All equipment have been stored correctly.

I ….Supervisor …………………………(Permit requestor) confirm that the work is completed and have checked that excavation is done as per design, excavated soil are kept at least 60cm away from _______________________
excavation. Signature, Date & Time

SUSPENSION/ CANCELLATION
Where monitoring of any type identifies contractor works which are not adequately covered by a Health and Safety MS/RA, all or specific parts of those works will be immediately suspended by the Supervision Consultant and/or the Employer until
satisfactory action is taken by the contractor to rectify the situation.
During the excavation process, works must immediately stop and further guidance must be obtained if any variance of services or conditions are found.
Conditions observed for suspension/ Cancellation of Permit:

NAME: ……………………………. SIGNATURE .............................................. DATE .................................

SOP-355 ATT. 7.8 Rev 5