Excavation Permit

Permit ID

All contractors, tenants and ADG staff must complete this Permit and have it approved before commencing any excavation and trenching work, including digging holes for posts and signs. The purpose of this Permit is to ensure that all safety and environmental aspects of excavation work have been considered and actioned, and to avoid damage to buried infrastructure and services.

Status

Are you or your business registered with ADG? *

YesNo

Note: registration is necessary before any work on ADG Leased Area is permitted.

*Please register your business with ADG before proceeding. Please click here to register

Have you completed the Working on Airport induction? *

YesNo

*Please complete the Working on Airport induction before proceeding with the application.

Part 1 – Application Details

Assessor *

Select Airport *

Applicant Name *

Phone *

ABN Number *

Business Name *

Email *Applicant's email address.

ADG Point of Contact/ Project Manager Details

ADG Point of Contact Name *

ADG Point of Contact Phone Number *

ADG Project Manager Email *

Other PM Email

Part 2 – Description of Works

Location Details

Address of Works *

Dates and Times of Work

Start Date of Works *

End Date *

*End date of works should be after start date of works.

Hours of Work From

Hours of Work To

Description of Works

Describe the planned works *

Date validation

Part 3 – Documentation

Safe Work Method Statement (SWMS) *

ProvidedNot Provided

Please attach SWMS

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Comments

Permit to Commence Work (PERCOW)

ProvidedNot Provided

Please attach PERCOW *

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Comments

Existing Services Plan

ProvidedNot Provided

NOTE: No mechanical excavation near identified existing services.

Please attach Existing Services Plan *

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Comments

Construction Environmental Management Plan (CEMP)

ProvidedNot Provided

Please attach CEMP *

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Comments

Stockpile Application Form (if surplus slurry or soil)

ProvidedNot Provided

Please attach the Stockpile Application Form *

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Comments

PFAS Statement (or exemption from Env. Manager) *

ProvidedNot Provided

Please attach the PFAS Statement *

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Comment

Other Permits

ProvidedNot Provided

Please attach other permits *

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Comments

Work site plan showing each proposed excavation including location and dimensions (length, width, depth) *

ProvidedNot Provided

Please attach the work site plan *

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Comments

Part 4 – Before Excavation Checklist

Will solid fencing be provided around open excavations? *

YesNo

Comments

Were underground services located? *

YesNo

Comments - underground services

Please attach the diagram

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Were underground fuel lines identified? *

YesNo

Do not start excavation works until Joint Aviation Fuel Services (JAFS) have been consulted. Contact the Safety team.

T: (08) 8920 1969
M: 0402 782 375
E: safety@adgnt.com.au

Is the excavation depth greater than 1.5 metres? *

YesNo

Comments

Is benching, battering or shoring being used? *

YesNo

Provide details *

Part 5 – Acknowledgement of Applicant

I confirm that:

I will comply with the ADG special conditions decided by the ADG Authorised Person.
I agree to repair and rehabilitate the site to its original condition or pay the costs associated with any repair work.
I agree to comply with all work health and safety requirements as outlined in our SWMS.
I will return my copy of this Permit for cancellation by the ADG Authorised Person, once work has been safely completed.

Name of Applicant *

Signature *

Draw signature|Type signatureClear

Date and time *

Part 6 – ADG Special Conditions

Please attach relevant documents (if any)

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Part 7 – Authorisation to Work

Is the permit approved? *

YesNoMore Information Required

Reason for disapproval/ Notes to the applicant *

I authorise the works listed above to proceed during the specified dates and times, in accordance with the ADG special conditions noted in Part 6 above. *

Name and Title of ADG Authorised Person *

Phone Number *

ADG authorised persons's signature *

Draw signature|Type signatureClear

Date and Time

Part 8 – Cancellation of Permit from the Applicant

Cancellation Date and Time

As-built drawings or amendments are

Not requiredRequired and will be provided by

Responsible Person

Provided by date

Please attach a photo of the site *

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I confirm that: *

The works described in this Permit have been satisfactorily completed or stopped and made safe.

The site has been re-filled and re-compacted as required and any irrigation systems and hard/soft landscaping have been restored to the satisfaction of ADG. *

Any outstanding matters have been forwarded on for action. *

This Permit is now cancelled. *

Name of Person in Charge of Works *

Signature of Person in Charge of Works

Draw signature|Type signatureClear

Date

Part 9 - Cancellation of Permit from ADG

Signature of ADG Authorised Person

Draw signature|Type signatureClear

Name of ADG Authorised Person *

Cancellation Date

CAPTCHA *

*Please fix the date above.

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