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Excavation Permit Form - Rev.0

This document is an excavation work checklist for Pembinaan Jaya Zira JV Iscorp Sdn Bhd, detailing the requirements and safety measures for excavation projects. It includes sections on excavation methods, soil classification, services in the vicinity, and necessary preparations to ensure safety and compliance. The checklist must be completed and signed by an engineer or supervisor before work begins, with specific attention to permits and site cleanliness.

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Talib Karim
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30 views1 page

Excavation Permit Form - Rev.0

This document is an excavation work checklist for Pembinaan Jaya Zira JV Iscorp Sdn Bhd, detailing the requirements and safety measures for excavation projects. It includes sections on excavation methods, soil classification, services in the vicinity, and necessary preparations to ensure safety and compliance. The checklist must be completed and signed by an engineer or supervisor before work begins, with specific attention to permits and site cleanliness.

Uploaded by

Talib Karim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PEMBINAAN JAYA ZIRA JV ISCORP

SDN BHD
EXCAVATION WORK CHECKLIST
Ref. No.: PJZJVISB/SHE/PTW/EXC/

Specific Location of Works: Type of Works: Routine

Sketch of Location: Yes (Attach Sketch of Location) Non-routine


No
N.A. Type of Excavations: Shallow excavation
Size of Trench or Excavations: Long: m Deep excavation
Wide: m (More than 1.2m deep)

Deep: m

EXCAVATION METHOD SOIL CLASSIFICATION


Use of machineries (Type: Excavator, Backhoe, etc.) Rock: %
Use of specialize equipment (Type: Mechanical digger, etc.) Sand: %
Manual hand excavates only Clay: %
Others (Please specified) Others (Please specified) : %

TYPE OF EXCAVATION WORKS EXCAVATION PROTECTIVE SYSTEM


Open trench excavation Sloping (Slope Degree: ᵒ )
Soil grading and leveling Benching
Digging / Pit construction Shoring: Raking Shores
Dredging Flying Shores
Pipe jacking Dead Shores
Others (Please specified) Box Shores
Others (Please specified)

SERVICES IN VICINITY OF WORK


1. Electrical Cable Yes No 5. Drainage Yes No
2. Telephone Services Yes No 6. Gas Line Yes No
3. Water Yes No 7. Signal System Yes No
4. Sewer Yes No 8. Others (Please specified) Yes No

AREA / EQUIPMENT / WORK PREPARATION **(Additional Justification to PJZJVISB when answer is “NO”)
1. Is the cut, cavity, or depression more than 4 ft (1.2 m) in depth? Yes No N.A.
2. If “Yes”, has sufficient numbers of ladders / stairways / ramps been installed for safe access and egress? Yes No N.A.
3. Is the cut, cavity, or depression more than 13 ft (4 m) in depth? Yes No N.A.
4. If “Yes”, has a registered Professional Engineer (PE) approved the drawing and procedure? Yes No N.A.
5. Are adjacent structures stabilized? Yes No N.A.
6. Have the excavation machineries been inspected? Yes No N.A.
7. Does the machine operator pose a valid Heavy Machinery License? Yes No N.A.
8. Have a competent person determine the soil type? Yes No N.A.
9. Have a competent person locate and marked all the underground utilities at the excavated area? Yes No N.A.
10. Has a piloting been conduct at the excavated area? Yes No N.A.
11.Are the edge of the cut, cavity, or depression exposed to any vehicular traffic? Yes No N.A.
12.If “Yes”, has a Traffic Management Plan been implemented accordingly to control the traffic flow at the excavated area? Yes No N.A.
13.Are the spoil / excavated materials placed 2 ft (0.61 m) or more from the edge of the cut, cavity, or depression? Yes No N.A.

1. Permit To Work (PTW) shall be applied before start works.


2. Original PTW shall be kept and recorded by Operation team.
3. Sign and approved copy of PTW shall be displayed at work area all the time.
4. This additional Checklist for Excavation Works shall be attached together with Permit To Work.
5. Keep all areas clean. Remove all trash, unnecessary tools / equipment at end of shift or after completion of the task.

I hereby acknowledge all the items mentioned in this Checklist attached are certified true.

Checked by (Engineer/Supervisor):

Signature :

Name :

Designation :

Date :

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