EXCAVATION PERMIT

Permit Number: [PERMIT-001] Site Address: [SITE ADDRESS] Project Name: [PROJECT NAME]

1. WORK DETAILS

Description of Work: [DESCRIBE THE EXCAVATION WORK] Location on Site: [DESCRIBE SPECIFIC AREA, EG REAR YARD NEAR FENCE] Start Date: [DD/MM/YYYY] Start Time: [HH:MM AM/PM] Expected Finish Date: [DD/MM/YYYY]

Maximum Depth of Excavation: [DEPTH IN METRES] Volume of Material to be Removed: [CUBIC METRES]

2. MACHINERY AND EQUIPMENT

Plant/Equipment to be Used: [LIST EQUIPMENT, EG 5 TONNE EXCAVATOR, TRENCHER, HAND TOOLS] Make and Model: [MAKE AND MODEL] Operator Name: [OPERATOR FULL NAME] Operator Licence Number: [LICENCE NUMBER]

3. UNDERGROUND SERVICES (Dial Before You Dig)

BYDA Ref Number: [REFERENCE NUMBER] Date of Enquiry: [DD/MM/YYYY]

Known Services in Area:

• Electrical
• Gas
• Water
• Telecommunications
• Sewer
• Stormwater
• Other: [SPECIFY]

Have plans been received? [ ] YES [ ] NO Have assets been potholed/located on site? [ ] YES [ ] NO Have assets been clearly marked? [ ] YES [ ] NO

4. RISK ASessment AND CONTROLS

Soil Type: [EG CLAY, SAND, ROCK] Ground Water Level: [NONE / HIGH / LOW]

Is ground support required? [ ] YES [ ] NO If YES, specify type (shoring, benching, shielding): [TYPE OF SUPPORT]

Hazard Identification:

• Overhead powerlines
• Underground services
• Traffic movement
• Public access
• Falling objects
• Noise
• Dust
• Confined space

Control Measures: [LIST SPECIFIC CONTROLS, EG USE SPOTTER FOR EXCAVATOR, INSTALL BARRICADES, USE DUST SUPPRESSION]

5. SAFE WORK METHOD STATEMENT

SWMS Reference Number: [SWMS-REF-001] Is the SWMS available on site? [ ] YES [ ] NO

6. AUTHORIZATION AND SIGN OFF

I confirm that:

1. I have read and understood the requirements of this permit.
2. The SWMS has been reviewed and controls are in place.
3. All underground services have been identified and protected.
4. The excavation area is clear of unnecessary personnel.
5. I am authorised to carry out this work.

Authorised Person (Site Supervisor): Name: [SUPERVISOR NAME] Signature: __________________________ Date: [DD/MM/YYYY] Time: [HH:MM]

Person Conducting Excavation (Permit Holder): Name: [OPERATOR NAME] Signature: __________________________ Date: [DD/MM/YYYY] Time: [HH:MM]

7. PERMIT CLOSURE

Work Completed: [ ] YES [ ] NO Area Made Safe: [ ] YES [ ] NO Excavation Backfilled: [ ] YES [ ] NA

Signed Off By: [NAME] Signature: __________________________ Date: [DD/MM/YYYY]