002 TW Permit to Work

• Work Site

• Site Location Plots/Area

• Prepared by

• Work Activity Title (Description)

  Footings

  Deep Drainage

  Internal Drainage

  Service connections

• Specified high-risk work tasks covered to work by this permit

  Hot Work

  Confined Space

  Excavation

  Other

• Start of Work

  Date

• Duration of Permit

Service Drawings

• Have Site inductions and RAMS been briefed and signed

  Yes

  No

• Are on-site service drawings available and have operatives carrying out the works been briefed on existing services.

  Yes

  No

CAT & Gennie

• Does at least one of the team hold a valid in date (3 years) CAT & Genny qualification?

  Yes

  No

• CAT & Genny Serial Number

• CAT & Genny Calibration Date

  Date

Trial Holes

• For identified services, have trial holes been dug by hand to ascertain service depths?

  Yes

  No

  None Identified

• Will hand digging with insulated tools be used when digging trial holes?

  Yes

  No

• What services were found?

  Gas

  Water

  LV

  HV

  BT/Fiber

• What depths where services located?

• Have service routes been marked with paint/pins?

  Yes

  No

• Are works deemed safe to proceed?

  Yes

  No

• Full Name and Signature of Supervisor

  Sign

Safe Trench/Excavation Practices

• Are Trench boxes being used for these works exceeding 1.2m?

  Yes

  No

• Will shallow excavations be stepped or battered back?

  Yes

  No

  No (Footings)

• When digging around services, will insulated tools be used?

  Yes

  No

Plant & Equipment

• Has all plant undergone a weekly inspection?

  Yes

  No

  N/A

• Are all operatives trained to operate plant?

  Yes

  No

  N/A

Works briefed and Explained

• Full Name and Signature of Supervisor

  Sign

• Full Name and Signature of Excavator Operator

  Sign

• Full Name and Signature of Other Operatives

  Sign

• Full Name and Signature of Other Operatives

  Sign

• Full Name and Signature of Other Operatives

  Sign

Completion of Works Sign-off

• Full Name and Signature of Supervisor

  Sign

• General Comments