THE FARADAY CENTRE LTD

Permit to Excavate
1. Permit Issue

1.1 Issuing Authority (name) ………………………………………………………

1.2 Position (Excavation Controller) ………………………………………………...

1.3 Issue Date …………………………….. Time ………………

1.4 Company ………………………………………………………

1.5 Permit Valid Until …………………………….. Time ………………

2. Work Details

2.1 Location of Work ……………………………………………………….

……………………………………………………….

2.2 Description of Work ……………………………………………………….

……………………………………………………….

2.3 Access to Work Area ……………………………………………………….

……………………………………………………….

2.4 Type of Excavation Manual only / Light machinery / Heavy Machinery

3. Services Checks

3.1 Drawing and document check for services.

All relevant drawings that were available were checked and the following
results were recorded on the drawings:

Check carried out no services found € No documents available €

Live Electrical Services found € Dead power cables found €
Pressurised water supplies found € Disused water pipes found €
Pressurised gas supplies found € Disused gas pipes found €
Working drainage systems found € Disused drains found €
Telecommunication cables found € Dead cables found €
Other Services were found €
Signed by responsible person ………………………………. Date ……………

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 THE FARADAY CENTRE LTD

3.2 Visual examination for obstructions

A visual inspection of the site has been carried out and the following potential
obstructions have been identified and recorded on the relevant drawings

Details of ground level obstructions ………………………………………………

…………………………………………………………………………………………

………………………………………………………………………………………….

Details of overhead obstructions …………………………………………………..

…………………………………………………………………………………………

………………………………………………………………………………………….

Any other obstructions ………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

Signed by responsible person ………………………………. Date ……………

3.3 Scan / Sweep of area with electronic surveillance equipment

I certify that the site of the excavation has been scanned / swept using a
approved survey tool and the position of any objects found has been recorded
on the relevant drawings and notified to the Excavation Supervisor.

Signed by responsible person ………………………………. Date ……………

4. Preparation

4.1 Is a Safety Method Statement attached to this document YES € NO €

4.2 Define and specify

(a) How the boundary of the site is identified ...……………………….

………………………………………................................................
(b) How the entrance to the site is identified ...……………………….
………………………………………................................................

4.3 Is a full or partial road closure necessary YES € NO €

4.4 Are traffic control measures required YES € NO €

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 THE FARADAY CENTRE LTD

5. Excavation Details

5.1 Details of work to be carried out ......................................................................

............................................................................................................................
............................................................................................................................
............................................................................................................................
............................................................................................................................
5.2 Excavation fall Safety precautions. What method is to be used to prevent falls

into the excavation. Solid Fence € Temporary Fence €

Cover Plates € Bunting & Signs €
6. Acceptance
I am authorised to carry out the work detailed on this document. I have read
and understand the Safety Method Procedure and agree that the measures
described in this permit are suitable for the work to be carried out safely. I
have briefed all the members of the working party on the scope of the work
and the safety measures.
Signature of the Working Party Supervisor ...............................................
Print Name ................................................ . Date ................................. ....
Employed by .................................................. Time ....................................

7. Clearance
I confirm that the work specified in this permit is completed / suspended. All
members of the working party have been withdrawn and all tools and
equipment have been cleared from the site.
Signature of the Working Party Supervisor ...............................................
Date ................................. .... Time ....................................

8. Cancellation
This permit and all copies of this permit are hereby cancelled
Signature of the Excavation Controller .......... ................................................
Date ................................. .... Time ....................................

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