Title Page
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Site conducted
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Completion Date
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Task Complete / Aborted
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Prepared by
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Location
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S Reference
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Permit Number
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Excavation Size (Example: 450mm X 500mm)
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Is this task complete or aborted?
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Surface Type
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Excavation
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Excavation - Network / Damage
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Excavation - Network / Repair
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Excavation - Back fill
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Excavation - Re-instatement
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Waste Transfer Note Complete
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Waste Removed (Photo of Area)
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Site Closed Down (Full area aspect Photo - all equipment / waste removed)
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Any near miss Incidents reported
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Why was the task aborted
- Gas Detected (GDU Alarm)
- Weather Conditions
- Asbestos Duct (OR)
- Hazardous Waste
- High Risk Area (Personal Safety)
- Excavation Below 1 metre
- Other (Detail in 'Other' notes section)
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Have you informed your Team Leader
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Team Leader Informed
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Photo Evidence for (Asbestos Duct (OR), Hazardous Waste, Excavation Below 1 metre)
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Additional Supporting Photo Evidence (If Required)
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Supporting Notes
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Is the site closed down?
- Excavation Open (Siteset up left in place)
- Excavation Closed (Reinstatement Complete)
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Site made safe and secure for the public?
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Site Photo
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Surface Type
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Excavation
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Excavation - Network / Damage
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Excavation - Network / Repair
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Excavation - Back fill
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Excavation - Re-instatement
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Waste Transfer Note Complete
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Waste Removed (Photo of Area)
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Site Closed Down (Full area aspect Photo - all equipment / waste removed)
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Any near miss Incidents reported
Sign Off
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Signature
