Title Page
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Client
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Permit to Dig Location
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Conducted on
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Conducted by
Supervisor Information
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Permit Location
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Chainage / Exact Location
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Location has been fully investigated
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Investigated by
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Authorisation to Dig is given to
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of Company
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for excavation works at the location detailed below for a distance of
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not exceeding a width of
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and at a depth not exceeding
Hazard Information
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All Hazards (e.g. Cables, Pipes etc) have been CLEARLY MARKED on site
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The depths and types of hazards are known?
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Further information / Notes / Relevant Information
Supervisor Signoff
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Authorisation to proceed
Operatives Signoff
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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
Completion signoff
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Works completed and left in a safe condition
