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Run: Excavation and Trenching Permit

Excavation and Trenching Permit template for authorizing ground disturbance after utility locates, soil classification, protective systems, and access contro...

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Permit Details

Permit Title (required)

Work Order or Job Number (required)

Permit Date (required)

Planned Start Date and Time (required)

Planned End Date and Time

Work Location (required)

Enter the specific plant area, building, line, or grid reference where excavation will occur.

Scope of Ground Disturbance

Type of Ground Disturbance (required)

Estimated Maximum Depth (feet) (required)

Estimated Length (feet)

Estimated Width (feet)

Work Description (required)

Briefly describe what will be done and why the disturbance is needed.

Utility Locates and Site Checks

Utility locates completed and verified? (required)

Locate Ticket or Reference Number

Known utilities and buried services marked on site? (required)

Yes No N/A

Overhead hazards reviewed, if applicable? (required)

Yes No N/A

Pre-job site walk completed? (required)

Yes No N/A

Soil Classification and Protective Systems

Soil Classification (required)

Protective System Selected (required)

Protective system installed before entry? (required)

Competent Person Name (required)

Competent Person Signature (required)

Access, Spoil, and Work Controls

Safe access and egress provided? (required)

Yes No N/A

Spoil pile placed at a safe distance from the edge? (required)

Yes No N/A

Barricades, barriers, or warning signs installed? (required)

Yes No N/A

Traffic or pedestrian control required? (required)

Traffic Control Plan or Controls

Hazards, Controls, and Authorization

Additional Hazards Identified

Additional Controls or Precautions

List any extra controls needed, such as isolation, monitoring, or standby support.

I confirm the information is accurate and understand work may not begin until this permit is approved. (required)

Yes No N/A

Submitter Name (required)

Submitter Role (required)

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