Excavation Permit and Checklist

TAISEI – DMCI JOINT VENTURE
North – South Commuter Railway Project (CP01)

Elevated Structures 6 Stations and Depot
EXCAVATION PERMIT
Date Issue: Location of work: Duration of work:
Contractor Name: Requested by:
Description and Location of work: Weather Condition:
Equipment to be used: Identification No: Operator/Worker Name: Spotter Name:
1 1 1 6 1
2 2 2 7 2
3 3 3 8 3
4 4 4 9 4
5 5 5 10 5
No. Description Yes No Not Applicable Remarks
1. Excavations and Protective Systems inspected by Competent Person
daily, before start of work
2. Maintain a safe distance of 1 meter from edge of the excavated area
such as excavated materials, machinery, equipment and construction
materials
3. Complete PPE in good condition and worn by all the employees
4. Warning signs and barrier provided at all excavations, wells, pits,
shafts, etc.
5. Employees are prohibited from working or walking under suspended
loads
6. Safe Access/Egress approximately 25ft. away from workers
7. Personnel and equipment are not directly working below or near the
excavation where another personnel or equipment is working above
8. Workers protected from loose rock, soil and protruding objects
9. Approve soil protection/ collapse protection as required on excavation
works are provided (Sloping, benching, shotcrete, shoring, shielding.
Sheet pile, etc.)
10. All personnel are aware of the hazards present and existing control on
the excavation activity
11. Warning system established and used when mobile equipment is
operating near edge of excavation
12. Emergency Preparedness and Response equipment readily available
near activity
UTILITIES
13. Utility companies contacted and/or located and exact location of
utilities marked when near excavation
14. Underground installations protected, supported, or removed when
excavation is open
WET CONDITION
15. Precaution taken to protect employees from accumulation of water
16. Water removal equipment monitored by Competent person
17. Inspection made after each rainstorm
Inspected by Name Signature Date
Subcon Safety Officer
Subcon Engineer
Approved by Name Signature Date
Subcon Project in Charge
Subcon Safety Head
Noted by Name Signature Date
TDJV Safety Officer
TDJV Engineer in Charge
EXCAVATION INSPECTION CHECKLIST

Date Issue: Location of work: Duration of work:

Contractor Name: Requested by:
Excavation Depth and Width: Soil Type: Weather Condition:
Equipment to be used: Identification No: Operator/Worker Name: Spotter Name:
1 1 1 6 1
2 2 2 7 2
3 3 3 8 3
4 4 4 9 4
5 5 5 10 5
No. Description Yes No Not Applicable Remarks
1. New Excavation Permit has been completed daily while excavation
activities ongoing
2. Is there an Emergency Rescue Procedure?
3. Approved soil erosion/collapse protection has been installed as per the
design (sloping, benching, shotcrete, shoring, shielding, sheet pile, etc.)
4. If required, designated and approved trench shields or boxes are in
place to protect workers
5. Employees are protected from loose rock or soil or other falling
objects above excavation
6. Are there any tension cracks along the excavation wall
7. Are the excavation walls showing signs of undercutting or erosion
8. Are there signs of bulging soil at the base of excavation wall
9. Are there signs of fault lines or failure zones developing on the
excavation walls
10. Excavated spoils, materials, and equipment set back minimum of 1
meter from edge of excavation and on downhill side if on slope
11. Adequate barricades or barriers provided at all excavations suitable
for people and equipment with signage
12. Safe access/egress installed as per the procedure. If the excavation is
larger than 17 meters multiple access/egress points installed 25 feet
distance
13. Mobile equipment is not operating within 1 meter of edge of
excavation unless installed ground support designated to control
loading
14. Exact location of utilities marked when near excavation
15. Underground installations protected, supported, or removed when
excavations are open
16. Is there water seeping or running into the excavation
17. Water pump installed as required and in working order
18. Surface water controlled or diverted
19. Is there potential for contaminated atmosphere present in the
excavation
20. Competent person has the authority to remove employees from the
excavation immediately
21. Is excavation considered a confined space and atmospheric gas is
required?
22. For egress in large excavation area, are two escape routes established
with appropriate stairs/ladder system?
23. Is illumination adequate in the excavation area for night works?
Inspected by Name Signature Date
Subcon Safety Officer
Subcon Engineer
Approved by Name Signature Date
Subcon Project in Charge
Subcon Safety Head
Noted by Name Signature Date
TDJV Safety Officer
TDJV Engineer in Charge

Excavation Permit and Checklist

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TAISEI – DMCI JOINT VENTURE

North – South Commuter Railway Project (CP01)

EXCAVATION INSPECTION CHECKLIST

Date Issue: Location of work: Duration of work:

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