GROUND DISTURBANCE PERMIT
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Operator
*
First Name
Last Name
Operator Email
*
example@example.com
Site Superintendent
*
Jamil Almoghrabi
Jamil El-Turk
JP Philion
Wassim El-Turk
Other
Site Superintendent Email
*
example@example.com
Work Site
*
RW-541 Sunridge Mall Snow Removal
RW-705 Bridgeland Improvements Project
RW-752 Carstairs Hwy 2A Improvements
RW-760 15th Avenue Mobility Improvements
RW-764 Sunnyside Flood Barrier 2025/26
RW-768 Saddlebrook Pavement Rehab
RW-771 CFD Apparatus Slab Replacement
RW-773 14th Street NW Pathway
RW-774 18th St SE Pathway
RW-778 Bow View Manor Emergency Work
UG-728 Mandalay Phase 5B
UG-730 NWIC Phase 2 (Kensington)
UG-743 Lawrey Gardens Outfall B76
UG-747 Cochrane Emergency Repairs
UG 754 - Water maintenance RFSO
UG-759 - Fish Creek Sludge Forcemain Upgrades
UG-761 Bow River Siphon Line Stop & Isolation Valve
UG-765 52 St and Memorial Dr. NE Feedermain
UG-766 2025 Watermain Replacement
UG-777B BPSFM Emergency Inspection Support
UG-777C Pipe Diver Installation
UG-779 Phase 4 Bearspaw Feedermain Repairs
UG-784 Shepard Energy Centre-Repair SOR
UG-785 Discovery Ridge Lift Station
UG-786 Bowness Park Cross Tie
CP-676 CP Rail Work
36 Avenue Yard
Balzac Shop
Spring Garden Lay Down
Company
*
Competent person trained in Ground Disturbance 2.0?
*
YES
NO
1. Have all utilities been marked and identified within proposed excavation area?
*
YES
NO
2. Have all affected parties been notified of excavation works?
*
YES
NO
3. Does the operator and workers have a copy of the locates and/or been shown where existing services are?
*
YES
NO
4. Has soil been classified prior to excavation taking place?
*
YES
NO
Confirm material type being excavated
*
5. Are protective systems required?
*
YES
NO
Confirm protective systems during the excavation process
*
6. Has the Excavator Operator and workers inspected the excavation prior to start of each work period?
*
YES
NO
7. Have all the work plans been discussed with all workers and the Site Superintendent?
*
YES
NO
8. Are all employees protected from cave-ins when entering and exiting the excavation?
*
YES
NO
9. Have hazardous objects around the excavation been removed or supported?
*
YES
NO
10. Is all spoil maintained at least 1 meter back from the edge of the excavation?
*
YES
NO
11. Are ladders used for access and egress?
*
YES
NO
11b. Are they placed as close as possible to the work area?
*
YES
NO
12. Are employees protected from loose materials or tools which could fall into the trench?
*
YES
NO
13. Are employees wearing the proper safety equipment?
*
YES
NO
14. Is the excavation free of standing or seeping water?
*
YES
NO
15. Is there evidence of cracking or sloughing of soil since the last inspection?
*
YES
NO
16. Is heavy equipment kept away from the edge of the excavation?
*
YES
NO
17. Are any changed conditions properly noted?
*
YES
NO
Additional comments on safety:
Excavator Operator Signature:
*
Back
Submit
Next
PERMIT APPROVED?
*
Yes
No
Comments
Site Superintendent Signature:
*
Site Superintendent Signature Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: