Excavation Permit - DOC by TPenney

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									   CALL BEFORE ANY OPEN EXCAVATION INCLUDING DAY LIGHTING                                                             PAGE 1 OF 1
   SAFETY, AND HEALTH PROGRAM                                                                           ATTACHMENT:   NA




EXCAVATION PERMIT
(For excavations 5 Feet (1.5 Meters) or greater)
(1) JOB INFORMATION
MARKET:                                                                  DATE:
PHYSICAL ADDRESS OF EXCAVATION:                                          COMPETENT PERSON NAME:
NAME OF SUBCONTRACTOR:                                                   SUPERVISOR/CREW LEAD:

(2) EXCAVATION DETAILS (ALL SECTIONS MUST BE COMPLETED AND AUTHORIZATIONS GIVEN PRIOR TO THE
COMMENCEMENT OF ANY TRENCHING OR EXCAVATION ACTIVITIES.)

A. Reason for the excavation?




B. Location of the excavation?

C. Approximate size of the excavation?

D. Soil Characterization?

E. What is the equipment and method for Shoring and/or Benching deemed necessary by the Competent Person?



F. Work to commence:                                                     Work to finish:

G. Civil drawings attached:                                                  YES           No


(3) POTENTIAL UTILITY INTERFERENCE

A. Locations and type?




B. Special precautions taken for each utility type identified?




C. Utility drawings attached?                                                YES           No



(4) AUTHORIZATIONS

Subcontractor Supervisor/Crew Lead:                  Competent Person Signature:                Date:

								
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