Excavation & Trenching Permit
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All Excavation Permits expire at midnight
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AM/PM Option
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Job Description and Location (be specific)
Means for Egress
Stairways
Ramp
Ladders
Other
Before Excavation (All soil will be considered type 'C' soil)
Requirements have been met and required data recommended
Proximity to utilities, buildings, footings or pilings, and sources of vibration
Owners of utilities, service, or transmission piping, (electrical, telephone, water, sewer)
Changing ground conditions, particularly after rain fall
Monitor for possible oxygen deficiency or gaseous conditions
Adequacy of shoring and/or sloping as work progresses
Change in vehicular and machinery operation patterns
Water removal equipment and operation
Adequacy of portable trench boxes or trench shields
Check for previously disturbed ground
Adequacy and availability of all equipment, including personal protective gear, shoring material, signs, barricades, and machinery
Other known obstructions (such as footing concrete encasement's)
Proper sloping
Overhead obstructions reviewed
For Trenches Over Five Feet (5') in Depth
Sloping and benching adequate
Timber shoring for trenches
Aluminum hydraulic shoring for trenching
Alternative to timber shoring
Selection of protective systems
Designed shoring (data must be filed on site)Note: Sloping or benching for excavations greater than 20 feet (6.1 meters) deep must be designed by a registered professional engineer.
Take picture of work area
Upload image of work area
Atmospheric Testing Required?
Yes
No
Air Test Reading
Comments
Competent Person Name
First Name
Last Name
Competent Person Signature
Electrical Manager Name
First Name
Last Name
Electrical Manager Signature
Equipment Operator Name
First Name
Last Name
Equipment Operator Signature
Supervisor Name
First Name
Last Name
Supervisor Signature
Mechanical Engineer Name
First Name
Last Name
Mechanical Engineer Signature
Civil Superintendent Name
First Name
Last Name
Civil Superintendent Signature
Submit
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