New Excavation Permit Form

Al Raha Beach Development
PERMIT TO EXCAVATE
Project Name & No Energization of Landscape Lighting Contractor Name THE BIRDS EMC CO.
Cabinet (DLC) at Al Raha Beach
Development
Permit Received Date 13-6-22 Permit approval No
ALDAR /ARCADIS accepts no liability for incidents, near miss, dangerous occurrence, authority permits, or any
property damages associated with permit issue
PERMIT STATUS
New Renewal –Ref:
A = Approved B = Approved as Noted (Page 4 of 4) C = Rejected
Part A: Request for a Permit (To be completed by contractor’s supervisor and HSE team and submitted to the Arcadis
Office. Permit will be issued by contractor’s HSE Department/Project Manager and approved by Arcadis)
Location & Dig / Grid /Al Raha Garden
References No
Permit No 10 Start Date End Date Aborted Aborted Time Actual Finish Actual Finish
Date Date Time
13-6-22 30-06-22
Name of Supervisor Contact Number Supervisor Email Address Name of Secondary supervisor
(Absent of Permit recipient)
Mr. Iqbal Hossain& Mr. 052-60788485 & Mr. Faizullah
Forhad 0526078848
EXCAVATION TYPE Trench (width ≤ depth)  Excavation  Pit
PROPOSED DEPTH 3.5 mtr
Purpose of Work Cable fault tracing , excavation for street light
Part B: Permit Recipient and Issue (Permit should be issued by Contractor’s PM /HSE Team and Permit recipient should
competent and certified)
Acknowledgement: I understand the hazards of this work and the precautions to be taken. I have ensured that these
have been fully explained to the operatives carrying out this work and consider them to be competent to do it safely. I
will closely supervise these works to ensure that they are carried out in accordance with terms of this permit, and I will
return my copy of this permit to the approved permit issuer /approver when this work has been safely completed.
Permit Received By Name Surname Signature Date
Excavation Supervisor
Mohammed Shiful 13-6-22
Permit Issued by
Contractor’s
HSE Team PM
Page 1 of 4
SOP/Arcadis/EHS/OSH/ARBD-Rev-19-September 2021
Part C: Requirements
NO Checklist YES NO N\A

1 Are approved risk assessment and method statements attached?
2 Is relevant authority NOCs are attached?
3 Are design and approval of temporary excavation Support ting system
by competent person?
4 Is the attached shop drawing of Support system for excavation above
1.2M?
5 Is specified zone references attached?
6 Have all utilities identified, marked and protected in their locations?
7 Is approved utility corridor drawing attached?
8 Is proper traffic control in place?
9 Emergency contact and arrangements are in place including first aid?
10 Are the appropriate access /egress provided?
11 Is all the equipment labelled as necessary?
12 Are notices /barriers displayed to prevent others from accessing area?
13 Is appropriate warning sign in Arabic and English?
14 Is adequate dewatering system in place?
15 Is adequate working space and lighting provided?
16 Have those involved been briefed on the method statements?
17 Is movement of vibrating Equipment away from the excavations
18 Is excavation supervisor competent certificate attached
19 Is permit obtained from ITC to work near road and if any road closure
required
Others: __________________________________________________________
Night Shift: (Reminder)
If Contractor working at night, it should be notified to Arcadis and approval to be taken 3 days prior to execution of work.
Signature: ( Contractor’s PM /CM and SO) Date: Time:
Part D: Permit Check, Review and Approvals
Name Designation Signature Date

Permit Checked by
Arcadis Logistic team Premod Kumar Logistic Eng.
Arcadis Infra Team Ricky P. ARE
Page 2 of 4
Aldar Team
Part E: Cancellation of Permit to Excavation (to be completed by Contractors Supervisor and /Contractor’s
HSE officer)
 I hereby declare that the work detailed in Part A has been completed /suspended and that all
persons under my charge have been withdrawn from the specified work area and warned that it is
no longer safe to work near or on the systems.
 Name: Signature: Date &time:
 I hereby declare that the work undertaken under this permit has been completed /stopped and that
the permit has been cancelled. (Contractor’s HSE Officer)
 Name: Signature: Date & time:
 Closing out from Arcadis
 Name: Signature: Date& time:
Notes for Guidance:
 Permit to excavate is only valid if signed off by all authority’s personnel

 Within 5m radius of live services, hand excavation only
 It is mandatory to have excavation supervisor always on site
 Any service that are not identified on appropriate drawings which are found during excavation,
contractor to suspend works immediately
 No excavation to commence without all appropriate approvals from all relevant authorities
 The excavation supervisor is appointed by contractor for sole purpose of managing site excavation
works, separate from general supervision or Foreman.
 Aldar/ Arcadis have the right to cancel the permit immediately if contractor does not follow and
implement permit requirements.
 Failure of contractor to implement permit requirements can lead to serious disciplinary
consequences and suspend the work.
 Contractor must submit the permit to excavate regardless of depth of excavation.
 Refer to OSHAD RF-CoP 29.0- Excavation and CoP 21.0 Permit to Work. www.oshad.ae
 During the execution of work Contractor to co-ordinate with Al Raha O & M Contractor
(M/S Engie Cofely) regarding the HSE related matters.
Page 3 of 4
Part F: Daily inspection, Extension and Renewal Sheet (This part to be filled daily prior commence to the
excavation by Contractor’s HSE Team and Site Engineer)
Date Name of Site Engineer Signature Name of HSE Personnel Signature
D1
D2
D3
D4
D5
D6
D7
Part G: Temporary Work Suspension (In case of any deviation on permit to excavate and unsafe condition on site,
permit will be suspended without prior notification)
Date Name Designation Signature
Remarks:
Part H: Resume the Work (if suspended the work, shall not be resumed the work without approval by Arcadis)
I ensure that all remedial action is completed by the Contractor,
Name: Signature: Date:
Remarks:
Page 4 of 4
General Comments:
 PTE is only valid until 7 days or as specified. To be closed after due date or request for renewal with
valid reason if require.
 All excavation shall be enclosed with plastic Jersey Barriers or orange net and to be daily maintained.
Safety Cones and Warning Tape no longer acceptable.
 PTE unused to be closed
 All excavation must have safety warning sign board.
 All excavation must have contact information board.
 All excavated materials shall be cover with green net.
 No PTE will be provided if a contractor has pending closed out PTE.
 Only manual excavation allowed.
 All damages to be reinstated.
 Obtain ADNOC from Royal Gas – Yes / No (Contact Mr. Robert 050 535 95 15)
Page 5 of 4

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Al Raha Beach Development

A = Approved B = Approved as Noted (Page 4 of 4) C = Rejected

EXCAVATION TYPE Trench (width ≤ depth)  Excavation  Pit

PROPOSED DEPTH 3.5 mtr

Purpose of Work Cable fault tracing , excavation for street light

NO Checklist YES NO N\A

Signature: ( Contractor’s PM /CM and SO) Date: Time:

Part D: Permit Check, Review and Approvals

Name Designation Signature Date

Arcadis Infra Team Ricky P. ARE

 Name: Signature: Date &time:

 Name: Signature: Date & time:

 Closing out from Arcadis

 Name: Signature: Date& time:

Notes for Guidance:

 Permit to excavate is only valid if signed off by all authority’s personnel

I ensure that all remedial action is completed by the Contractor,

Name: Signature: Date:

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