PERMIT TO DIG AND EXCAVATION PERMIT

Permit Number: [PERMIT-001]

1. PROJECT DETAILS

Project Name: [Project Name] Site Address: [Full Street Address, Suburb, State, Postcode] Client Name: [Client Business Name]

2. EXCAVATION DETAILS

Description of Work: [e.g. Excavation for building foundations] Location of Dig: [e.g. Rear of property, near western boundary] Start Date: [DD/MM/YYYY] Expected Finish Date: [DD/MM/YYYY]

Dimensions:

• Length: [metres]
• Width: [metres]
• Depth: [metres]

Excavation Method: [e.g. 1.5 Tonne Excavator / Hand Digging]

3. HAZARD IDENTIFICATION AND CONTROLS

Underground Services

Have current Dial Before You Dig (BYDA) plans been obtained? [Yes / No] Reference Numbers: [BYDA Reference Number] Have services been located by potholing/hydro vacuum? [Yes / No] Controls in place: [e.g. Services marked in white paint, hand digging within 1m of services]

Ground Stability

Soil Type: [e.g. Clay / Sand / Rock] Risk of Collapse: [Low / Medium / High] Ground Support Method: [e.g. Benching / Shoring / Trench Box / N/A]

Overhead Hazards

Are there overhead powerlines? [Yes / No] Controls: [e.g. 'No Go' zones established, spotter used]

Traffic and Public

Is the excavation near a road or public access? [Yes / No] Is a Traffic Management Plan required? [Yes / No] Controls: [e.g. Bunting and signage erected, traffic controller on site]

4. PLANT AND EQUIPMENT

Machinery to be used: [e.g. Bobcat, Excavator, Trucks] Operator Name: [Full Name] Operator Licence Number: [Licence No. - if applicable for HRW]

5. CERTIFICATION AND SIGN-OFF

I certify that I have inspected the site, reviewed the hazards and controls listed above, and it is safe to proceed with the excavation work.

Excavation Supervisor: ______________________________ Name: [Supervisor Name] Signature: __________________________ Date: [DD/MM/YYYY] Time: [HH:MM AM/PM]

I acknowledge I have read and understood the controls and conditions of this permit.

Site Manager / PCBU Representative: ______________________________ Name: [Manager Name] Signature: __________________________ Date: [DD/MM/YYYY]

WORK TO STOP IMMEDIATELY IF:

• Unexpected underground services are found
• Ground conditions change or rain causes instability
• Nearby structures show signs of movement
• Unsafe work practices are observed