<p> EXCAVATION / ROAD CUTTING PERMIT</p><p>Format No : HSE – 10 Rev 0</p><p>Contractor: M/s …………………………………………………………………………….</p><p>Location …………………………………………………………………………………. …………………………………………………………………… ( Enclose sketch ) Description of work : …………………………………………………………………….</p><p>Method of Excavation: Manual / Mechanical</p><p>Permission is solicited from :………………………( Date )………………………..….hrs. To : ………………………( Date ) …………………………....hrs.</p><p>Site Engineer (Initiated By) Sig. of Safety Officer (Checked By) Sig. of Eng.-In-Charge(RCM) Name …………………….. Name …………………….. Name …………………….. Signature…………………… Signature…………………… Signature…………………… Safety checks for Road Cutting/ Excavation work Existing Not Existing Precautions Underground Telecommunication line Underground Electrical Cable Underground Sewer / drinking water line Underground Fire water line Underground Product / Utility line</p><p>Excavation is provided with hard barricade : YES / NO Excavation is provided with Ramp / Steps : YES / NO</p><p>Permission is granted for the above mentioned job. Permit will ensure that all precaution stated above are observed.</p><p>Permission is solicited from :………………………( Date )…………………………..hrs. To : ………………………….( Date ) ……………….…….…..hrs.</p><p>Elect. Co-ordinator, EIL Area .Co-ordinator, EIL Safety Deptt. EIL Name ……………….. Name …………… Name …………… Signature……………. Signature…………… Signature…………… Main Contractor’s site engineer shall abide by the precautions / conditions stated all over)</p><p>Note : - Permit to observe precautions as mentioned above. - Barricading with tape/ hard barricading should be done on all said of excavation. - Excavation & Road Work Procedure as per OISD-192 must be followed. - Permit must be available at the site of work. </p><p>GRANT OF PERMIT AND EXTENSIONS</p><p>Extension Period Work Time Sl. Contractor Site Site Engineer From ______From: Hrs No. Engineer (PMC) To______To: Hrs</p><p>01</p><p>02</p><p>03</p><p>04</p><p>05</p><p>06</p><p>07 EXCAVATION WORK PERMIT</p><p>PROJECT : SITE : DATE : Work Time : From ______Hrs. To ______Hrs : EXACT LOCATION OF EXCAVATION : </p><p>Format no.: /HSE/ </p><p>1) Type of Job :- </p><p>2) Depth of Excavation: 3) Excavation as per Drawing. :…………………….. YES / NO 4) Excavation provided with slop:………………….. YES / NO 5) Excavation is near to Drain / CSS :……………….. YES / NO 6) Excavation is provided with hard barricade:…….. YES / NO 7) Excavation is provided with Ramp / Steps:……… YES / NO 8) Tool box talk introduced: YES / NO 9) Precaution taken for heavy vehicle. a) Warning sign board:…………………………… YES / NO b) Back stops on rear wheel:……………………... YES / NO c) Vehicle with reverse alarm:……………………. YES / NO</p><p>10) Persons working at work place with PPE:…….. YES / NO 11) Ensure Manual Excavation upto 1.5 M resorting to mechanical Excavation Sig. of Site Engineer/Eng.-In-Charge Sig. of Safety Officer </p><p>(Initiated By) (Checked By)</p><p>Permission is granted to work : Yes / No</p><p>EIL (Electrical) EIL (Safety)</p><p>GRANT OF PERMIT AND EXTENSIONS</p><p>Sig. of Safety Work Time Sig. of Site Verification Validity Period Officer Sl From _____ Engineer/Eng.- by EIL From______Checked By No. Hrs. In-Charge of (Electrical) To ______(Safety Officer) To ______Hrs Contractor with date of Contractor</p><p>Additional safety instructions, if any:- </p>