PERMIT CHECK POINTS
PTW NO : ………………. Location: ……………….
Validity From:___________ To:_______________
Excavation Work Permit
Excavation work involves are all activities that required to dig soil for any purpose can not start without work permit.
Measure Remarks
Instruction to Personnel regarding hazards and working procedure (TBT record)
1 YES NO N/A
2 Underground services are checked YES NO N/A
3 Water level and soil condition checked. YES NO N/A
4 Excavation plan clearly shows side sloping and width shoring YES NO N/A
Barricading of the area done
5 YES NO N/A
6 Access to excavator and worker is available YES NO N/A
7 Warning signs like “Deep excavation, work in progress” are displayed YES NO N/A
Operator of all excavation machinery is having valid licenses
8 YES NO N/A
9 Entry to unauthorized persons is restricted YES NO N/A
Proper side slope is maintained
10 YES NO N/A
Suitable dewatering arrangement has been made
11 YES NO N/A
All workers have been provided with suitable PPE
12 YES NO N/A
All electrical connection has been checked for damage, and provided with ELCB
13 YES NO N/A
No material is loaded near the edge of the pit(Minimum 1.5m distance must be
14 YES NO N/A
maintained from the pit edge)
Nobody is working in the excavated area without permission.
15 YES NO N/A
Disposal area is clearly specified.
16 YES NO N/A
Suitable ladder or steps provided if depth of pit is more than 1.2meter
17 YES NO N/A
No person below 18 Yr. age is working on site
18 YES NO N/A
Excavated pit is covered to avoid falling of personnel
19 YES NO N/A
20 Sufficient illumination level available YES NO N/A
21 Any other Precautions taken:- ………………………………………………………………………………………………………………..
Tick As Applicable
Fire extinguisher at place Security Guard / Helper Non Sparking Tools Bucket of water
Bucket Of Sand Fire watcher Provision Of low Voltage Light Fire Hose prepared
Post Work Fire inspection Communication Flying Sparks protection Escape route + kept Clear
Fire resistant clothing Electrical Tools Grounded Ventilation Barriers, Warning signs
Respirators Safety Harness With Life line Miscellaneous
I have checked the above points and found conditions suitable to undertake the work:
________________________________________
Permit Applicant ( Site Enng/ Sr. Sup):- Name ( in block letters) / date/ signature
Note: Excavation work Permit can be ontained for One shift only & it can be extended for the immediate next shift if the work could not be completed with in one shift.
Section in-charge - Name/Signature/Date Cross check by Safety person - Name/Signature/Date
Note :- We the undersigned, hereby confirm to perform the above mentioned work in compliance with the relevent legal requirements, industrial
practices, site rules and regulation and Rustomjee safety guidelines. Implemetation of above safety standards /precautions shall be the sole
responsibilty of the contractor performing the work. The site management of the Rustomjee assumes no liability in this regard.
PERMIT CHECK POINTS
Note :- We the undersigned, hereby confirm to perform the above mentioned work in compliance with the relevent legal requirements, industrial
practices, site rules and regulation and Rustomjee safety guidelines. Implemetation of above safety standards /precautions shall be the sole
responsibilty of the contractor performing the work. The site management of the Rustomjee assumes no liability in this regard.
