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Permit to dig example

Completed permits for common jobs: both sheets, filled in and cancelled. Read one, download it, then issue your own from the blank.

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Permit to dig example

A new drain in a yard, near live services

Hand digging near a cable and a gas pipe, over two days, with inspections after rain.

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What to change

  • Your site and exact location
  • The precautions that do not apply, and why
  • Who issues it and who accepts it

Sources

Checked

  1. Permit to DigHollins & Reed Contracting LtdPermit no.HR-0419SiteUnit 3, Canal Side Business ParkExact locationEast yard, gully to manhole MH2DetailsContractorValid toIssued toRAMS refValid fromDrawing, dateHollins & ReedPriya Shah14/10/26 08:0014/10/26 16:30HR-RAMS-09HR-D-02, 05/10/26The workWhere, depth, methodHand dig zoneTrench 6 m long, 1.2 m deep. Breaker through concrete, then mini excavator with a spotter.Hand tools only near marked lines. Breaker 500 mm off them. Insulated tools by the cable.HazardsElectricityDrains and sewersWater ingressGasDistrict heatingTrafficWaterContaminated groundServices unknownTelecomsUnstable groundPrecautionsDoneByDrawings obtained and datedScanned with locator and signal generatorServices marked on the plan and groundTrial holes hand dugServices exposed and supportedEdge protection and ladders in placeSpoil kept back from the edgeSides supported or batteredInspected at the start of each shiftGas monitoring, traffic managementDan Hollins, 05/10/26Dan Hollins, 13/10/26Dan HollinsPriya Shah, two holesNot needed. None crossedReece OllertonReece OllertonPriya Shah, supportsDan HollinsReece Ollerton, barriersServices made deadHowLockedTagProved byNothing isolatedAll services stay livePeople on this permit: nameCompanyBriefedPriya ShahHollins & ReedReece OllertonHollins & ReedOther conditionsTreat every service as live. Re-scan as the trench deepens. Unknown service, stop and ring 0161 496 0142.Cable struck, driver stays in the cab. Nobody goes near until the owner makes it safe.Sign-offNameSignatureDateTimeIssued: precautions checkedAccepted: permit understoodDan Hollinssigned14/10/2607:45Priya Shahsigned14/10/2607:50Worked example of a made-up job. Not a permit. · Page 1 of 2
  2. Permit to DigHollins & Reed Contracting LtdPermit no.HR-0419SiteUnit 3, Canal Side Business ParkExact locationEast yard, gully to manhole MH2DateTimeByResultExcavation inspections14/10/2613:00Dan HollinsTrench at 0.9 m. Supports in, sides sound, barriers up.15/10/2607:45Dan HollinsStart of shift, after rain. Pumped out. Sides sound.15/10/2612:45Dan HollinsBefore backfilling. Sides, supports and barriers sound.CancellationBackfilled or securedServices as foundDrawings marked upBackfilled in layers. Concrete reinstated 15 October. No concrete around services.Cable and gas pipe where the drawing shows. Neither touched.New drain added to HR-D-02. Copy to the site plan.HandbackIsolations removedArea returned toNotesNone were madeThornley Vale Estates Ltd, site keyholderYard open again. Barriers gone.Sign-offNameSignatureDateTimeExtended: new end timeCancelled: area checkedHanded back: area returnedDan Hollins, to 15/10 16:00signed14/10/2616:15Dan Hollinssigned15/10/2615:30Dan Hollinssigned15/10/2615:40Worked example of a made-up job. Not a permit. · Page 2 of 2

The same sheet as text

Worked example of a made-up job. Not a permit.

Sheet 1: Permit to Dig

Hollins & Reed Contracting Ltd

  1. Permit no.HR-0419
  2. SiteUnit 3, Canal Side Business Park
  3. Exact locationEast yard, gully to manhole MH2

Details

  1. ContractorHollins & Reed
  2. Issued toPriya Shah
  3. Valid from14/10/26 08:00
  4. Valid to14/10/26 16:30
  5. RAMS refHR-RAMS-09
  6. Drawing, dateHR-D-02, 05/10/26

The work

  1. Where, depth, methodTrench 6 m long, 1.2 m deep. Breaker through concrete, then mini excavator with a spotter.
  2. Hand dig zoneHand tools only near marked lines. Breaker 500 mm off them. Insulated tools by the cable.

Hazards

  1. ElectricityYes
  2. GasYes
  3. WaterYes
  4. TelecomsNo
  5. Drains and sewersYes
  6. District heatingNo
  7. Contaminated groundNo
  8. Unstable groundYes
  9. Water ingressYes
  10. TrafficYes
  11. Services unknownNo

Precautions

  1. Drawings obtained and datedDone: yes. By: Dan Hollins, 05/10/26
  2. Scanned with locator and signal generatorDone: yes. By: Dan Hollins, 13/10/26
  3. Services marked on the plan and groundDone: yes. By: Dan Hollins
  4. Trial holes hand dugDone: yes. By: Priya Shah, two holes
  5. Services exposed and supportedDone: no. By: Not needed. None crossed
  6. Edge protection and ladders in placeDone: yes. By: Reece Ollerton
  7. Spoil kept back from the edgeDone: yes. By: Reece Ollerton
  8. Sides supported or batteredDone: yes. By: Priya Shah, supports
  9. Inspected at the start of each shiftDone: yes. By: Dan Hollins
  10. Gas monitoring, traffic managementDone: yes. By: Reece Ollerton, barriers

Services made dead

  1. Nothing isolatedHow: All services stay live. Locked: no

People on this permit: name

  1. Priya ShahCompany: Hollins & Reed. Briefed: yes
  2. Reece OllertonCompany: Hollins & Reed. Briefed: yes

Other conditions

  1. Treat every service as live. Re-scan as the trench deepens. Unknown service, stop and ring 0161 496 0142.
  2. Cable struck, driver stays in the cab. Nobody goes near until the owner makes it safe.

Sign-off

  1. Issued: precautions checkedName: Dan Hollins. Signature: signed. Date: 14/10/26. Time: 07:45
  2. Accepted: permit understoodName: Priya Shah. Signature: signed. Date: 14/10/26. Time: 07:50

Sheet 2: Permit to Dig

Hollins & Reed Contracting Ltd

  1. Permit no.HR-0419
  2. SiteUnit 3, Canal Side Business Park
  3. Exact locationEast yard, gully to manhole MH2

Excavation inspections

  1. 14/10/26Time: 13:00. By: Dan Hollins. Result: Trench at 0.9 m. Supports in, sides sound, barriers up.
  2. 15/10/26Time: 07:45. By: Dan Hollins. Result: Start of shift, after rain. Pumped out. Sides sound.
  3. 15/10/26Time: 12:45. By: Dan Hollins. Result: Before backfilling. Sides, supports and barriers sound.

Cancellation

  1. Backfilled or securedBackfilled in layers. Concrete reinstated 15 October. No concrete around services.
  2. Services as foundCable and gas pipe where the drawing shows. Neither touched.
  3. Drawings marked upNew drain added to HR-D-02. Copy to the site plan.

Handback

  1. Isolations removedNone were made
  2. Area returned toThornley Vale Estates Ltd, site keyholder
  3. NotesYard open again. Barriers gone.

Sign-off

  1. Extended: new end timeName: Dan Hollins, to 15/10 16:00. Signature: signed. Date: 14/10/26. Time: 16:15
  2. Cancelled: area checkedName: Dan Hollins. Signature: signed. Date: 15/10/26. Time: 15:30
  3. Handed back: area returnedName: Dan Hollins. Signature: signed. Date: 15/10/26. Time: 15:40

What a completed permit shows

  • Who issued it and who accepted
  • What was checked first, and what did not apply
  • The record while it ran (fire watch, gas tests, inspections)
  • How it was cancelled and handed back

Two ways to run your permits

On paper, from this book

Print the two sheets, number them and issue one for each job.

Get the blank

Keep the day’s record

Note each permit issued and cancelled in Site Diary, with photos of the area.

Open Site Diary

Permit to work example questions

Are these real permits?

No. Every job, company, person and address here is made up, and so is every reading. They show what goes in each box.

Can I issue one of these as it is?

No. A permit is written for one job, one place, one time. Issue your own from the blank, after checking the place yourself.

What makes a permit invalid?

It covers only the job, the place and the time written on it. If the time runs out or the work changes, stop, then extend it or issue a new one once it is checked as safe. HSE: HSG250.

How long does a hot work fire watch last?

At least an hour of continuous watching after the hot work ends, then at least one more check two hours after the end. HSE: HSG168.

Where is the blank?

On the permit to work template page. Add your logo, then print it or download it.