Excavation/Ground Disturbance Permit
Project
*
Please Select
2800048-PAVH
2800052-Virtual Health Hub
2820099-St. Pauls Power Plant
2820107-MN Learning-PA
2820113-SRC SXU TdDy Concrete and Steel
2820114-BourgaultMachineHQ
2820116-Cameco McArther River
2820118-St Johns Cathedral Repointing
2820119-Saskatoon City Hospital Acute Care Project
2820121-AAFC Roof Replacement
2820122-Innovation Sask Tenant Decanting
2820123-AAFC Seed Storage Building Expansion
2840037-Theodore Spillway Upgrades
Your Cell Phone Number
*
So we can text you when permit is approved/rejected.
Format: (000) 000-0000.
Email (copy of final permit will be sent here)
*
example@example.com
Date
*
/
Month
/
Day
Year
Date
Company
*
Work Performed by:
Drawing:
*
Location of Excavation:
*
Reason for Excavation
*
Person Responsible for the Excavation
*
Start Date
*
-
Month
-
Day
Year
Date
Permit Expires
*
-
Month
-
Day
Year
Permit Expiry to be verified by Site Superintendent
Utilities present in the Excavation Area
Water
Sewer
Gas
Power
Fire Lines
Process Lines
Others
Water Comments:
Sewer Comments:
Gas Comments:
Power Comments:
Fire Lines Comments:
Process Lines Comments:
Other Comments:
Special Utilities (Check all those that apply):
% O2
Explosion testing
Gas/fume testing
Standby person
Hand excavate at utility crossing
Grounding of tools
Barricades
Special Clothing
Fall Protection
Other Special Utilities (Specify)
Additional Comments?
Craft Superintendent of Craft Excavating
*
Signature of Craft Superintendent
Client Representative (If in an operating facility)
Signature of Client Rep (If in an operating facility)
Excavation Competent Person
*
Signature of Competent Person
PCL HSE Representative
*
PCL Superintendent if no HSE Rep on site
Signature of PCL HSE Representative
Soil Classification:
*
Stable Rock
Type 1
Type 2
Type 3
Type 4
Have all procedural requirements been met and documented?
*
Yes
No
N/A
Is the excavation close to utilities, buildings, footings, pilings, source of vibration?
*
Yes
No
N/A
Have utilities, etc., been located?
*
Yes
No
N/A
Has a check for the previous excavations in the area been made?
*
Yes
No
N/A
Have adequate supplies of equipment, PPE, shoring material, signs, barricades, machinery, etc., been assured and checked?
*
Yes
No
N/A
Additional obstructions/hazards:
List additional obstructions/hazards here
Other obstructions/hazards:
*
Yes
No
N/A
Slope Will Be:
*
Slope Comments:
Depth of Excavation:
*
Specify unit of measure
Width of Excavation:
*
Specify unit of measure
Length of Excavation:
*
Specify unit of measure
Do vehicular and machinery operation patterns need to be changed?
*
Yes
No
N/A
Will water removal operations/equipment be needed?
*
Yes
No
N/A
Have trench boxes or trench shields been checked?
*
Yes
No
N/A
Entrance/Exit means (maximum travel distance to exit 25ft/8m)
Stairways
Ladders
Ramps
Competent Person
*
Date
*
-
Month
-
Day
Year
Date
Preview PDF
Submit
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