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    Nigm - MZC - Excavation Permit

    Uploaded by

    Umair Syed
    PTW form for Excavation

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Nigm - MZC - Excavation Permit

    Uploaded by

    Umair Syed
    8 views3 pages
    PTW form for Excavation

    Original Title

    NIGM - MZC - EXCAVATION PERMIT

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    PTW form for Excavation

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    8 views3 pages

    Nigm - MZC - Excavation Permit

    Uploaded by

    Umair Syed
    PTW form for Excavation

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    National Innovative General Maintenance

    Doc. No. NIGM-HSE-PTW-02


    LLC
    Rev./
    Integrated Management System 00
    Issue
    ISO 9001:2015 – ISO 45001:2018 -
    Date 30-05-2019
    ISO 14001:2015
    Page 1
    Permit To Work – Excavation Work

    CLIENT CONSULTANT CONTRACTOR

    PERMIT FOR PERMIT NO DATE APPLIED


    (Company)
    SECTION I Description of the Work

    Location of work

    Description of work

    Approx. duration of From AM To (Time) PM


    work (Time)

    Name of operative

    Name of task in-


    charge

    Permit Issued on: From AM To (Time) PM


    (Time)
    SECTION II Checklist for Safety Controls
    PRIOR TO COMMENCEMENT CHECK DURING EXCAVATION CHECK
    Determine soil condition A competent person to supervise excavation

    Identify existing services Constantly check excavated walls for cracks


    Prior to excavation check the adjacent
    Spoils are to be dumped minimum 4m away
    structures
    Arrange adequate edge protection Persons not to work near the moving bucket

    Erect signage Ensure all round vision for machine operators

    Put vehicle stops all around Ensure banks man present

    Make room for earth spoils If ladders are placed, secure them (Ramp)
    Arrange proper accesses and
    Inspect excavation before use and every 7 days
    egresses
    SECTION III (Permit Requested by):
    I request for a permit for the above-mentioned work at the location specified above. I have personally inspected the workplace
    to ensure that requirements needed as precautionary measures as mentioned above have been complied with.

    Name (Site …………………………………….


    Signature ………………………………….. Time …
    Engineer/Site
    Supervisor): …
    SECTION IV Authorization for the Work to Proceed
    Work shall be carried out (only) after complying with the requirements of section II and the following (if any).

    This valid up to (Time) ………………………………………………. Date: …………………………………………..

    Project Manager / ………………………. Signatur ………………………………….. Time …………………………………..


    National Innovative General Maintenance
    Doc. No. NIGM-HSE-PTW-02
    LLC
    Rev./
    Integrated Management System 00
    Issue
    ISO 9001:2015 – ISO 45001:2018 -
    Date 30-05-2019
    ISO 14001:2015
    Page 2
    Permit To Work – Excavation Work

    Site Engineer: e

    SECTION V Safety Officer/ Engineer Recommendation (Applicable for both day and
    Night shift)
    Recommendation:

    Sub contractor - Name:………………………………. . Signature:……………………….. Date:


    ………………………..

    Contractor - Name:………………………………. Signature:……………………….. Date:


    ………………………..

    The work is not completed and the renewal of permit requested for additional hour.

    Additional hours Hrs. to Hrs.


    from Date:

    SECTION VI (Closing of Permit)

    JOB COMPLETED AND THE PERMIT IS CLOSED:

    Signature, Date & Time of the Permit Holder:

    Signature, Date & Time of the Safety Officer

    To be returned to HSE Office after the completion of the work and duly closing of the
    Permit

    SECTION VII Cancellation of Permit)

    CANCELLATION OF CLEARANCE By NIGM

    This permit is hereby cancelled

    Engineer In-charge

    NAME DESIGNATION

    SIGNATURE DATE
    National Innovative General Maintenance
    Doc. No. NIGM-HSE-PTW-02
    LLC
    Rev./
    Integrated Management System 00
    Issue
    ISO 9001:2015 – ISO 45001:2018 -
    Date 30-05-2019
    ISO 14001:2015
    Page 3
    Permit To Work – Excavation Work

    NOTE: PTW can be cancelled anytime without notice if site condition is unsafe or legal and
    contractual obligations are disregarded.

    COPY OF THIS PERMIT SHALL BE HELD WITH THE “ENGINEER / FOREMAN” AT ALL TIMES

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