Corporate Safety – Form
Excavation and Penetration Permit
CExcavation and Penetration Permit
Date
/
/
Permit to Work No
Work Order No
Description of Work
Exact Location of
Proposed Work
If the Permit is open more than one shift, the excavation and associated works must be inspected before re-commencement of work.
YES
Checklist
NO
Is there a JSEA for this task?
Has an RTHA been undertaken?
Is the penetration on a Greenfield site or using high pressure water/vacuum excavation?
Is the excavation or penetration ≤300mm? If yes to any of these, permit is not required.
All underground services positively located and marked, “Dial Before You Dig” service
contacted on 1100 for public area plans, Seqwater drawings offered for company sites.
N/A

Has the nature of the ground been investigated (soil/rock/sand, wet/dry, etc)
Is a geotechnical assessment required (excavation adjacent to buildings or underground
services, trench support required etc).
Possibility of flooding or water inundation managed (drain, run off, etc).
All shoring and support issues addressed (any trench >1.0m must be benched or battered;
>1.5m requires shoring or shielding unless deemed safe by geotechnical assessment).
Any spoil and equipment to be >1.0m from the excavation.
Are any overhead hazards present over work site? If yes, spotter is required.
Machinery safety consideration? (location to excavation, condition, safe operation)
Excavation/trench secured from unauthorised access by the erection of signage &
barricading?
Where possible, is barricading erected ≥ 1.5m from edge of trench?
Are personnel required to enter the trench? If yes, complete Excavation Entry Section Below
Excavation Entry Section
Means of access/egress considered: Ladders at 9m intervals or ramps/steps.
Approved support system in place: Shoring, shielding, benching: approved by Geotech engineer.
Emergency response plan developed and available. Emergency personnel and equipment onsite

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Standby person/spotter available. Will be required.
Is excavation greater than 1.2m? If yes, Confined Space Entry Permit is required.
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Other controls
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I confirm that all controls above are in place and all workers understand the requirements of this permit.
”g
2nd Tier Permit Authority
Contact No
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Signature
Date
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Work Completion
re
I have inspected the worksite. I am satisfied that the work is completed and the site safe
vr
2nd Tier Permit Authority
iv
Date
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Signature
ec
Doc no.
Doc owner:
Version date:
Trim ID:
FRM-00413
20/12/2012
Doc approver:
Rev no.
Y Dong
Manager, WH&S
The controlled version of this document is registered. All other versions are uncontrolled
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Corporate Safety – Form
Excavation and Penetration Permit
1. Types of Work

Any work where objects such as star pickets penetrate the ground >300mm

Installing foundations or services

Excavations for project or construction work
2. Mandatory PPE/tools

Hand tools for potholing near services

Approved plant and equipment for conducting excavation works

Approved ladders

Standard PPE including safety eyewear, safety gloves, safety footwear, safety helmet
NOTE: Other PPE /tools may be required to be used
3. Prior to starting work

Will the work interfere with other contractors, personnel or the general public,
especially for access and egress?

Depending on the depth will battering, benching, shoring or shielding be required?

Have all services and underground structures been identified?

For services, is isolation/de-energising needed to conduct the work?

Has a geotechnical engineer been consulted for the type of work?

Where the work area contains overhead structures or powerlines, or if person’s are
entering the excavation, a spotter will be required for the period of works

Recovery plans are understood and equipment is available for immediate use

Barricading and other controls in place or available to restrict access to area

Considerations for management if excavation is to remain open after the shift

Ensure working in isolation does not occur

Competency of personnel to operate equipment

Have controls been considered for adverse weather conditions?

Where entry is required, have access and egress points been identified?
4. Precautions to be taken during work

Always wear the PPE provided and indicated

When in the excavation, Never work directly below the item of plant or the boom

Always ensure the plant operator is made aware of location of persons working near
the equipment.

Never place equipment or spoil within 1m of the excavation. These may need to be
further away depending on the soil and support types.

If conditions or controls change, STOP, move away from the work area and re-assess

Equipment and access is secure if the area is left unattended

Inspections must be completed to check the trench integrity if the excavation is left
unattended
5. Completion of Work

Ensure excavated area is compacted if needed to prevent slumping

Ensure area is free of debris and all equipment removed
Doc no.
Doc owner:
Version date:
Trim ID:
FRM-00413
20/12/2012
Doc approver:
Rev no.
Y Dong
Manager, WH&S
The controlled version of this document is registered. All other versions are uncontrolled
2
Page 2 of 2