Work Plan

Is the location of excavation submitted to engineer ? ( GTS 5.1.2, PTS 1.2.2 )

Define the reason ?

Is the excavation indicated at Contractor's Three Week Programme ?

Define the reason ?

Is the traffic division informed about excavation ?

Define the reason

Which utility operator is informed ?

Define the reason why not informing ?

Environment and H&S

Environmental Precautions

Is there any precautions related to Noise Control ?

Explain the reason

Shoot the photo of equipment related to Noise Control

Is there any precautions related to Dust Control ?

Explain the reason

Shoot the photo of equipment or ground conditions

Is there any precautions related to Waste Control ?

Explain the reason

Shoot the photo of equipment related to Waste Control
Health and Safety Precautions

Is fire extinguisher provided properly ?

Is first medical aid provided properly ?

Is the personnel protective equipment ( ppe ) provided ?

Define the name of the staff is not used the PPE.


Name and Surname of Staff

Shoot the Person's photo
Define the PPE is not used or not proper.

Is there any pedestrian access need near the working area ?

Is there any pedestrian bridge located ?

Explain why not ?

Add media

Is there any vehicle access need near the working area ?

Is there any vehicle routing set ?

Explain why not ?

Add media

Are the site signs provided properly at working area ?

Add media

Are the barriers located and secured the excavation area on site ?

Add media

Are equipment, machines and transportation vehicles in a good state, having no noxious effects concerning environment and human life ? ( H&S Plan )

Material and Design

Material and Equipment

Are all equipments which is indicated in work method statement at site ?

Please indicate which equipment is absent

Shoot all equipment located at site

Are the materials stocked up safely on working area ?

Shoot the material on site

Do pipes and fittings comply the specifications ? ( GTS 5.2 and PTS 7.2 )

Define HDPE fittings

HDPE Fitting
Connection Type

HDPE Fittings

Define the DI fittings

DI Fitting
Connection Type

Ductile Iron Fittings from SMS

Define the pipes




Permit Confirmation

Permit to Work

Have the all requirements met by Contractor on site ?

Define the critical issues should be completed.

Should be sign by Contractor's Site Manager or Representative

I understood the requirements that not exist on site. We have no claim rights due to this situation
Date and time of suspending the permit

Excavation Permission is given providing the above appropriate conditions. Further part of this audit will be filled after finishing the works.

Permit start by
Permit is expired after
Permit should be refreshed when Contractor reached to
Contractor's Site Manager

Should be sign by Hüseyin Dönertaş. (In case of absence of him, it's contractor's risk of any failure)

Consultant's Site Supervisor
MESKI's Staff

Final Control of Works

F/O Cable

Has F/O Cable conduit been placed correctly ? (PTS 4.13.4, PTS 4.13.5)


Has backfilling been completed properly ?

Do material types of bedding, filling and backfilling comply the specifications ( GTS 5.1.6)

GTS 5.1.6


Is there any excavation works less than 1 m height ?

Has concrete cover, where the depth of pipe is less than 1.00 m, been complied ? ( GTS, GTS 6.1 )

Is curing applied to concrete satisfactory ?

Add media

Has surface been reinstated to first condition after excavation ?

Reinstatement details


Type of surface at part of road


Lenght is

Made by

Site Safety After Works

Is there any opening remain at working area ?

Is it safe for citizens ?

Add media
Permit from
Permit to

Pipe installation





Confirmation by Contractor's Site Manager

Should be sign only Site Manager (Hüseyin Dönertaş)

Confirmation by MESKI
Confirmation by Consultant

This form is not giving the right to Contractor hand-over the works to Client. Performance Guarantee and Contractor's responsibility is still valid according the Contract terms.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.