Excavation Authorization

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EXCAVATION AUTHORIZATION

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Form Number: 2025/TS/QA/EX/069

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Employee ID*

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Employee Name*

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Position Description*

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Phone Number*

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Department*

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CEO Office Section*

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EM Section*

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Operations Section*

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HR , ADMIN & IT Section*

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HSE Section*

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Finance Section*

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TS Section*

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COD Section*

Request of Executing department

Department*

OPER.

MECH

Civil

E&I

FIRE

I-Purpose*

ii Location*

P&ID*

Drop files here or

Max. file size: 512 MB.

*

iii Size o Excavation (IN METERS.) DEEP…

WIDE

LONG

iV Commencing Date*

MM slash DD slash YYYY

Valid till: (Maximum one month)*

MM slash DD slash YYYY

V Supervisor. Name

B-Excavation is granted, underground utilities checked and verified:

Remarks:(IF YES ADD COMMENT BELOW)*

C-SAFETY REQUIREMENTS:*

Cold Work permit- hand excavation only

Barricade- tape/ hard

Provide fire extinguisher

Road closure circular

Provide warning signs

Soil Protection- Slope/ shoring/ benching

Excavated soil 0.5m away from edge

C. S. Entry permit (depth>1.2m)

Provide flashing lights

Provide means of access

Hot Work permit-Mechanical excavation

D-EXCAVATION RENEWAL (each max. one month)

Renewed till date

Supervisor (Executing Department)

Operations Shift in charge

HSE Rep.

E-EXCAVATION CLOSURE:

Excavation site restored to normal /safe condition

Excavation continues/remains open

Backfilled

YES

NO

Properly Compacted

YES

NO

Re-asphalted/repaired with concert

YES

NO

Facilities /Supports restored

YES

NO

Remarks

Supervisor (Executing Department)

Agreed that excavation restored to our satisfaction. Remarks:

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