JOC: 0916 927 189

Attached to PTW No:

NSRP COMPLEX PROJECT
EXCAVATION CERTIFICATE
APPLICABLE TO ALL PILING WORKS, GROUND DRILLING AND ALL ACTIVITIES MORE THAN 30CM IN DEPTH REQUIRES EXCAVATION PERMIT
Associated Documents:

 METHOD STATEMENT
 JSA
 PLOT PLAN / DRAWING
 EXCAVATION CLEARANCE CERTIFICATE MARKED UP U/G FACILITIES DRAWING

From : To:
Planned Work Date

Company: Work Location: No. of Workers:

Details of Excavation Length = Width: Depth:

TO BE COMPLETED BY PERMIT RECEIVER

Method of Excavation: Manual Mechanical

Trial Excavation Required? YES NO U/G Cable Detection Required? YES NO

Scope / Details of work:

Tools and Equipment to be used:

Task Supervisor's Name Badge Number: Contact Number:

Hazard identification:
U/G Obstructions Overhead Power Cables Confined Space Adjacent Works (SIMOPS)
Cave in / Engulfment Vehicle Movements Traffic Control

SAFETY REQUIREMENTS / PRECAUTIONS TO BE TAKEN

Conduct "START" / hazard assessment / Safety Briefing prior to work start

Provide adequate safe access and egress
Cable detection for U/G obstructions to be conducted by competent person
Identify all buried U/G services with markers (e.g.: Electical cables, piping etc..)

Overhead power cables "less than" 3 meters, TEMPORARY FACILITIES VERIFICATION AND APPROVAL REQUIRED.
Stockpile > 1m from edge of trench
PERMIT ISSUER

Reinforce excavation shores to avoid collapse

Identify disposal area for excavated soil
Require traffic control for obstuction of emergency routes
Dewatering pump and equipment shall be available
Combustion engines shall be located on safe distance from excavation.

I ACKNOWLEDGE THAT ALL PREPARATION WORKS AND SAFETY REQUIREMENTS ARE IN PLACED AND THAT THE WORK IS SAFE TO PROCEED

PTW Issuer (JGCS Area Supervisor / Engineer) : Contact Number: Signature: Date:

From : To:
Permit Validity
ACCEPTANCE

I ACKNOWLEDGE THE RECEIPT OF THIS CERTIFICATE AND UNDERSTAND FULLY THE CONDITIONS AND PRECAUTIONS REQUIRED.
I WILL ENSURE THAT ALL PERSONNEL UNDER MY AUTHORITY UNDERSTAND THESE REQUIREMENTS.
Permit Receiver (Task Supervisor ): Contact Number: Signature: Date:

This certificate is to be shown at work site with relevant Method Statement, JSA, RA and other relevant permits (if applicable)