Title Page
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Document ID: FW-SHEQ-TEM-20
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Location
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Conducted on
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Prepared by
Untitled Page
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Work must not start until Sections A, B and C of this permit have been completed and signed by authorised persons
Section A. Project details
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Location
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Date and Time issued
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Supervisor in charge of works
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Brief description of works
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Client
Operatives
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Name of NRSWA accredited operative (attach picture of Street Works card)
Section B. Precautions to be taken before work is carried out (To be completed by the supervisor in charge of the works)
Essential procedures
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Safe Dig Drawings issued and dated within last 3 months?
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Drawings show the location, type and status of underground services
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Live services made dead as far as possible or necessary
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Work area surveyed by a competent person, using appropriate detection equipment to confirm the exact location of underground services, also look for visual identifiers
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Location of services marked on the ground
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Valid method statement and risk assessment in place
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Method statement and risk assessment explained to the operatives carrying out the work
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Person in charge of the excavation is fully conversant with the principles of safe digging and/or avoidance of underground services (HSG47)
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All operatives familiar with safe excavation practices
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If plant is being used, operator is competent and familiar with safe equipment used
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Has a Cable Avoidance Tool been used?
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Insert type and serial number
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When is calibration due
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Confirmation by contractor’s supervisor: I confirm that the precautions specified above will be complied with and I will ensure that the persons carrying out the work, described above, are fully briefed on the safe method of work
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Sign off
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Date
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Confirmation by operator(s): I understand the precautions to be taken in carrying out the works
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Sign off
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Date
Section C. Completion of work (To be completed by the supervisor in charge of the works)
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I am satisfied that:
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the excavation has been backfilled and the surface reinstated
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the work is completed and the area has been left in a safe condition
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the work area is clear of operatives and all equipment
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the utility company(ies) has been informed that services made dead may now be reactivated
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I am not satisfied that the work has been completed satisfactorily; the additional work described below must be completed before this permit may be cancelled
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Additional work that is necessary to enable this permit to be cancelled
Section D. Cancellation and closure of permit (To be completed by the supervisor in charge of the works)
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I am satisfied that all work has been completed and this permit is now cancelled
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Sign off
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Date
