EXCAVATION

RISK ASSESSMENT & EXCAVATION PERMIT Section 1 Risk Assessment

Document the hazards and analyse the risks associated with the excavation or digging activities to be undertaken.

P.T.W. Number:

Location of exca ation! BAC Area / Location: Likely depth of excavation works: Reason fo" exca atin#! Work activity description: Nature of work to be undertaken and method of excavatin :

300mm to 1.5 M 1 M to 1.5 M in known sandy or unstable locations > 1.5 M

$a%a"& i&entification' "isk ana()sis an& cont"o( meas*"e se(ection! S+ecific Exca ation ,o"k Iss*es!
tick a!!ro!riate" #he excavation work is to be solely undertaken by a contracted !arty $% &'( !ersonnel and a detailed work method statement ) risk assessment has been !reviously !re!ared* reviewed by &'( + is attached to this ,orm. #he excavation work is to be solely undertaken by &'( !ersonnel as !er the s!eci-ic excavation work issues detailed below. Step 2 Consider Likelihood What is the likelihood (below) of the hazard consequence in Step 1 occurring. (lmost Cert in LikelPossible .nlikel- / ! re %s e$pected to occur in most circumstances Will probabl( occur at least once *+ent might occur at some time *+ent not e$pected to occur or onl( in e$ceptional circumstances

Add an additional pa e if the space below is insufficient! Attac- &oc*mentation & +"ocee& to Section . on t-e fo((o/in# +a#e0 Com+(ete t-e Risk Assessment 1e(o/0

Risk Assessment Guide

Step 1 Consider Consequences What are the consequences of this hazard occurring? Consider what is the most probable consequence (below) with respect to this work hazard. )*treme Critic l & ,or &inor +nsi$ni0ic nt &ultiple fatalities or permanent in'uries Single fatalit( or permanent in'ur( &edical treatment or lost time in'ur( ,irst aid treatment %ncident or near miss - no treatment Step 3 C lcul te !isk 1. ake Step 1 rating and select the correct column. !. ake Step ! rating and select the correct line. ". #se the risk score where the two ratings cross on the matri$ below. " # "i$h% S # Serious% & # &edium% L # Lo' Consequences +ns &in & , Crit )*t (lmost Cert in & S " " " Likel& & S " " Possible L & & S S .nlikel- / ! re L L & & S

$a%a"&
.ist the hazards relating to the work"

Cont"o(s
.ist the controls to manage each o- the hazards"

)ikelihood

Res+onsi1(e Pa"t)
.ist the role* contractor* com!etency +)or !rescribed occu!ation res!onsible -or im!lementing the controls"

Risk Assessment
/ith controls in !lace0 1igh* 2erious* Medium or .ow"

Risk Assessment Pe"sonne(!

%isk 'ssessment (om!leted by0

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EXCAVATION
RISK ASSESSMENT & EXCAVATION PERMIT Section . Exca ation Pe"mit
's !er the method o- excavation and work described in "ection #* identi-y control re5uirements in the relevant !arts below.

P.T.W. Number:

3n&e"#"o*n& Se" ices I&entification #y!e o 6n-ormation sourced ) to be sourced -rom authority or underground asset service locator services 7isual ins!ection and search o- the work area and !otential services in the surrounds identi-ication0
tick a!!ro!riate"

$ial Before %ou $i & Call ##''"

4xisting &'( services ma!s or !lans reviewed ) to be reviewed

Man&ato") 8 9nderground service location and de!th detection undertaken ) to be undertaken

6denti-ication undertaken by0 1ave 4es 2ervices have been identi-ied that could im!act on the excavation tasks. services No been #here are no services in the area ) vicinity that could im!act on the excavation tasks. identi-ied:
Se" ice t)+e
3ominate the ty!e o- service s" identi-ied0 water* stormwater* sewerage !i!eline or services* irrigation lines* control wiring* gas or -uel tank)!i!eline* telecommunications* live)unknown electrical* non live electrical* etc0

Date0
(om!lete this 2ection ;roceed to (olla!se + 4ntry (ontrols 2ection

P"oximit) of se" ice tick a!!ro!riate"0 5e+t- &etai(s! 2ervice directly where 2ervice in !roximity o- as detected +)or excavation re5uired re5uired excavation as a best estimate"

/here a service has been identi-ied* insert in-ormation in the service location and restrictions sections below to ensure a sa-e method o- work

Se" ice (ocation6s7 ;rovide details)descri!tion o- locations as detected* or an ex!lanation o- areas shown by marking !aint or similar"0

Rest"ictions 6inc(*&in# f"om se" ice o/ne"7 to ens*"e safe /o"k ;rovide details)descri!tion o- work restrictions re5uired"0

Exca ation Co((a+se & Ent") Cont"o(s

/ill workers be re5uired to enter the excavation s": '0 &0 /ill the excavation s" be greater than 1.5 m dee!: ' sa-e means o- entry will be achieved via must identi-y one"0 ;revention o- colla!se will be achieved via must identi-y at least one"0

4es No 4es No

;roceed to 6tem ' ;roceed to 6tem ( ;roceed to 6tem & ;roceed to 6tem (

#he use o- secured ladders 8 at least one !er <m section o- trench #he -ollowing alternative sa-e means0 #he use o- shoring #he use o- battering to all sides re5uired #he use o- benching to all sides re5uired ' written and signed authority
obtained -rom certi-ied geo=technical engineer stating that the excavation is sa-e -or entry"

>eneral sa-e entry in the excavation will be achieved via

both items mandatory"0

(0

>eneral sa-ety to be achieved via0 ;revention o- colla!se will be achieved via must identi-y at least
one"0

More than one !erson being !resent at the excavation during entry ' com!etent !erson to su!ervise work* ins!ect excavation s" and ;roceed to 6tem D maintain an excavation log daily !rior to entry ' com!etent !erson to su!ervise work and ins!ect excavation s" 3o controls re5uired to !revent a !erson being tra!!ed by a colla!se 9sing shoring* battering)benching to !revent a !erson being tra!!ed ;roceed to 6tem D by a colla!se or to minimise likelihood o- a -all

D0

(lari-ying details as a!!licable about ty!e oshoring* method o- !lacement)removal* batter)bench dimensions* access details* etc0

A&&itiona( Consi&e"ations #ick as 4xclusion ) barricading is to be erected to exclude access ) !revent -alls a!!ro!riate (ontrols will be re5uired to limit o!erating areas o- earthmoving !lant (lose=by exhaust -umes could make the excavation atmos!here unsa-e -or entry (ontrols are re5uired to !revent undermining o- near=by structures #he area is likely to contain contaminated soil ) old !rocess materials ) chemicals 3ew services will need to be marked ) identi-ied +)or service !lans u!dated Pe"mit Re8*est!

6nclude relevant control details within 2ection 1 8 %isk 'ssessment or an attached /ork Method 2tatement

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EXCAVATION
RISK ASSESSMENT & EXCAVATION PERMIT

P.T.W. Number:

#his acknowledgement signi-ies a -ormal re5uest to commence excavation works. 's the !erson re5uesting this !ermit* 6 hereby certi-y that0 6 am com!etent to coordinate this excavation work in accordance with the !revious %isk 'ssessment + 4xcavation ;ermit details? 6 shall undertake to im!lement all !lanned and necessary controls to ensure sa-e excavation access and work methods? and 6 shall monitor the excavation ) work hazards and control methods throughout the excavation work.

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9AC A*t-o"isation!
#his &'( 'uthorisation signi-ies that the !lanning com!onent o- the %isk 'ssessment + 4xcavation ;ermit has been com!leted and that excavation work is authorised to commence in accordance with the ;ermit %e5uest.

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Section 2 Im+(ementation Exca ation ,o"ks A*t-o"isation (Work Coordinator in $irect Control):
#he !rocedures* control measures and !recautions a!!ro!riate -or the sa-e access +)or execution o- work involving this excavation s" have been im!lemented and the !ersons re5uired to work have been advised o- and understand the re5uirements o- the %isk 'ssessment + 4xcavation ;ermit.

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#his 'uthorisation is valid until the -ollowing occurs* or the date and time shown0

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