CX Paving Solutions - Permit to Dig

• Client / Site

• Permit to Dig Location

• Conducted on

  Date

• Conducted by

Supervisor Information

• Permit Location

• Chainage / Exact Location

• Location has been fully investigated

  Yes

  No

  N/A

• Investigated by

  Sign

• Authorisation to Dig is given to

• of Company

• for excavation works at the location detailed below for a distance of

• not exceeding a width of

• and at a depth not exceeding

Hazard Information

• All Hazards (e.g. Cables, Pipes etc) have been CLEARLY MARKED on site

  Yes

  No

  N/A

• The depths and types of hazards are known?

  Yes

  No

  N/A

• Further information / Notes / Relevant Information

Supervisor Signoff

• Authorisation to proceed

  Sign

Operatives Signoff

• The operatives involved in the work have understood the method of work, received specific instructions, are aware of the hazards (including location and depth) and how they have been marked

  Sign

Completion signoff

• Works completed and left in a safe condition

  Sign