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Excavation Permit

( This Permit is valid for one shift not to exceed 12 hours )
Jobsite :
Jobsite Area :
Date / Time Permit Initiated:* Fecha / Hora Permiso Iniciado:*
Date / Time Permit Expires:* El permiso de fecha / hora expira:*
Location Name:* Nombre del lugar:*
Location Description:* Descripción de la ubicación:*
Type of excavalion (Choose one):
 Trenching
 Drilling
  Boring
  Underpinning
Company:
Competent Person :
Phone Number :
Description of Excavation Work to be Performed :

Equipment to be utilized :
  Yes No N/A Competent Person (initial) TCCO Staff (initial) Precautions/Restrictions/Comments
Has "One Call" notification been made ?
Verification No. :
Available records referenced, and As Built drawings indicating location of underground facilities provided and available for reference at the work site?
Hydro Excavation Investigation Method used to locate depth and direction of utilities
Proposed excavated area(s) identified and all underground facilities in the dig zone and search zone have been marked (Circle method)
   
Precaulions have been taken to prevent contact with overhead power lines.
Name required spotler
Location of underground utilities noted on drawings and provided to operator and posted in trailer?
Name of operator
Shoring Required?
Indicate type of shoring
Sloping Required?
Indicate angle of repose
Possible enviormental issues have been considered and addressed ?
Utility identified which requires protective actions? (Circle all that apply);
           
"Think Before You Dig" Presentation reviewed?
Crisis Management Plan in place?
Have proper authorities been notified?
Has Turner Staff and Excavation crew walked the area?
Surface features that may indicate underground utilities: Area lights/signs, phone lines,drain lines,electrical boxes/lines, matural gas meter/line, water meter/line. sewer drop inlets/manholescleanouts, air connections, fire hydraouts, steam lines, sprinkler systems.pipeline/cable makers. pavement/
Safety huddle and JHA review held with all team members?
Potential Hazards            
Undermined Structures
Previously disturbed soil
Traffic location
Traffic vibration
System shutdown required?
Additional comments, instructions or requirements :
Excavation crew and any relevant personnel have been informed of the hazards, impact and status of all work which may affect their operations or other ongoing work.
(Circle all that apply)            
6. Signatures
Attach the completed job Hazard Analysis (JHA), Excavation Plot Plan Drawing, GPR survey and other required documentation to this permit and submit to the following for authorization signatures.

Using your finger, sign on the line below:
 clear signature
  Print Name Signature
Subcontractor Competent Person :

Using your finger, sign on the line below:
 clear signature
Turner Superintendent :

Using your finger, sign on the line below:
 clear signature
Turner Safety (if necessary) :

Using your finger, sign on the line below:
 clear signature
Other :

Using your finger, sign on the line below:
 clear signature
 
   
 
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