Excavation & Trenching Permit

Excavation & Trenching Permit
***NOTICE***

Although this permit is not required for contractor excavation and trenching activities on Pulsar Helium (the Company) location, it is made available as an example to contractors who provide services to Pulsar Helium. The Company requires contractors to utilize their company-required permitting system when conducting excavation and trenching work on a Company location.
Date

MonthDayYear
Date
Job Supervisor

First NameLast Name
Supervisor Email
example@example.com
Equipment Operator(s)
Location where excavation will occur
Description of excavation
Excavation Size
Controls

Are hazards controlled
Will workers enter trench

YesNo
Atmosphere
Oxygen shall read between 19.5% and 23.5%

LEL must read 0%
Means for Egress

StairwaysRampLadder(s)Other

Before Excavation (All soil will be considered type 'C' soil)

	Yes	No
One call been performed
Overhead and underground utilities been identified and marked
Owners of utilities, service, or transmission piping been identified (electrical, telephone, water, sewer)
Pilings will be set back at least 18 inches
Changing ground condition(s) anticipated (particularly after rain fall)
Monitor for possible oxygen deficiency or gaseous conditions
Adequacy of shoring and/or sloping as work progresses
Water removal equipment available if needed
Portable trench boxes or trench shields available if needed
Check for previously disturbed ground conducted
Adequacy of all equipment, including personal protective gear, shoring material, signs, barricades, and machinery
Proper sloping

Excavations over 5' feet in depth

	Yes	No
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).
Is trench deeper then 20' feet? Note: Sloping or benching for excavations greater than 20 feet (6.1 meters) deep must be designed by a registered professional engineer.

Controls