M4E Safety Essential Verification - Live Services & Excavation Permits- Rev 1

• 

• Parramatta Road - Area - Activity - Task

• WestConnex M4E - Parramatta Rd Civil

• Safety Essential Verification - Live Services & Permits - Rev 1

• Conducted on

  Date

Area Supervisor:-

• Select Daniel Taylor Simon Baldwin MIchael Paton Ben Ashcroft David Wilson Brandon Leong Dave King Peter Masiororski Ben Forbes Vaughan Kimmins Mitch Stevens Bob Isaac John Kim Joe Vu Danielia Cullura

  • Daniel Taylor
  • Simon Baldwin
  • MIchael Paton
  • Ben Ashcroft
  • David Wilson
  • Brandon Leong
  • Dave King
  • Peter Masiororski
  • Ben Forbes
  • Vaughan Kimmins
  • Mitch Stevens
  • Bob Isaac
  • John Kim
  • Joe Vu
  • Danielia Cullura

Lead Inspector:-

• Select Daniel Taylor Simon Baldwin MIchael Paton Ben Ashcroft David Wilson Brandon Leong Dave King Peter Masiororski Ben Forbes Vaughan Kimmins Mitch Stevens Bob Isaac John Kim Joe Vu Danielia Cullura

  • Daniel Taylor
  • Simon Baldwin
  • MIchael Paton
  • Ben Ashcroft
  • David Wilson
  • Brandon Leong
  • Dave King
  • Peter Masiororski
  • Ben Forbes
  • Vaughan Kimmins
  • Mitch Stevens
  • Bob Isaac
  • John Kim
  • Joe Vu
  • Danielia Cullura

Other members of the inspection team?

• Select Daniel Taylor Simon Baldwin MIchael Paton Ben Ashcroft David Wilson Brandon Leong Dave King Peter Masiororski Ben Forbes Vaughan Kimmins Mitch Stevens Bob Isaac John Kim Joe Vu Danielia Cullura

  • Daniel Taylor
  • Simon Baldwin
  • MIchael Paton
  • Ben Ashcroft
  • David Wilson
  • Brandon Leong
  • Dave King
  • Peter Masiororski
  • Ben Forbes
  • Vaughan Kimmins
  • Mitch Stevens
  • Bob Isaac
  • John Kim
  • Joe Vu
  • Danielia Cullura

• Another auditor

Excavation and Penetration Permit review. Have the "Above the Line Controls" been implemented and live service(s), have been visually verified.

• Is there a valid Work Permit and approved SWMS in place for the work being performed?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Take Photo of Permit

  Media

• Has the Permit been registered by the Permit Issuer and is it valid within the time frame?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• What services have been identified in the Excavation or Penetration Permit ?

  Select Electrical +11Kva Electrical - 11Kva Water Gas Communications Sewer Other

  • Electrical +11Kva
  • Electrical - 11Kva
  • Water
  • Gas
  • Communications
  • Sewer
  • Other

• Has a Dial Before you Dig & As built (GIS) Drawings identified for Electrical services and are clearly marked in the location?

• Has a Dial Before you Dig & As built (GIS) Drawings identified for Gas services and are clearly marked in the location?

• Has a Dial Before you Dig & As built (GIS) Drawings identified for Communications services and are clearly marked in the location?

• Has a Dial Before you Dig & As built (GIS) Drawings identified for Water services and are clearly marked in the location?

• Has a Dial Before you Dig & As built (GIS) Drawings identified for Sewer services and are clearly marked in the location?

• Has a Dial Before you Dig & As built (GIS) Drawings identified the other services?

• Are the Dial Before You Dig Drawings or As built, clear and identify the services or do then need expanded?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• New drawings must be reproduced that identify the services clearly.

• Live services (underground, embedded, concealed or overhead) are to be eliminated by relocating or diverting services away from the work zone. If this cannot be done, one or more of the following controls must be used:

  Select De-energies the service Physical barrier to protect the service Elevating the service out of the work zone Concealing the service behind a physical barrier Preventing work activities encroaching safe approach distances by installing physical barriers or selecting smaller equipment or using alternative work methods Safety Essential Exemption has been approved for the works

  • De-energies the service
  • Physical barrier to protect the service
  • Elevating the service out of the work zone
  • Concealing the service behind a physical barrier
  • Preventing work activities encroaching safe approach distances by installing physical barriers or selecting smaller equipment or using alternative work methods
  • Safety Essential Exemption has been approved for the works

• Potholing and Safe Approach Distances for Underground Services

  

• Prior to any surface disturbance, have all services been located by

  Select Dial before you dig Asset owners advised and As built drawings obtained Vehicle Movement Plans and / or traffic Management Plans in place A Survey of the area has been completed identifing overhead services and heights Services isolated by Autherised Isolator Electronic detection / GPR scanning scheduled and buried or concealed service to be clearly marked with paint along alignment Out of service statements have been received for redundant services from relevant authority (where supplied) Associated Permits identified and completed (e.g. Confined Space Entry). Service isolation confrimation has been initiated and scheduled Proximity to other buildings, roads and structures assessed as safe in engineers report Design drawings are attached and design does not pose a service hazard Plant wheel loadings ahave been considered for scheduled working vicinity Approved SWMS are iin place detailing work methodology and safety controls & attached If hard surface is to be removed in next phase, surface location painted and visually inspected Parallel and converging services are identified for location All known concealed and buried services within 3 meters have been indentifed and marked for indetification Is ther a histroy of unkown services in area and should non invasive digging be used

  • Dial before you dig
  • Asset owners advised and As built drawings obtained
  • Vehicle Movement Plans and / or traffic Management Plans in place
  • A Survey of the area has been completed identifing overhead services and heights
  • Services isolated by Autherised Isolator
  • Electronic detection / GPR scanning scheduled and buried or concealed service to be clearly marked with paint along alignment
  • Out of service statements have been received for redundant services from relevant authority (where supplied)
  • Associated Permits identified and completed (e.g. Confined Space Entry).
  • Service isolation confrimation has been initiated and scheduled
  • Proximity to other buildings, roads and structures assessed as safe in engineers report
  • Design drawings are attached and design does not pose a service hazard
  • Plant wheel loadings ahave been considered for scheduled working vicinity
  • Approved SWMS are iin place detailing work methodology and safety controls & attached
  • If hard surface is to be removed in next phase, surface location painted and visually inspected
  • Parallel and converging services are identified for location
  • All known concealed and buried services within 3 meters have been indentifed and marked for indetification
  • Is ther a histroy of unkown services in area and should non invasive digging be used

• What controls are in place prior to the removal of hard surfaces?

  Select Dial Before you dig VMP in place Parallel and converging services have been located Plan identifies all burined, concealed and overhead services Services have been isloated Hydro-vacuum Hand digging Electronic detection GPR scanning comppleted and all services burried or concealed clearly marked Pot holing / slit trenching intervals defined Plant wheel loading considered Emergency Response and Rescue Plan approved Contaminated ares controlled Calibrated GPR wands in good condition Survey of area completed Hydro excavation is limited to no no more than 13800kpa/2000psi Hard surfaces have been removed to conduct pot holing All known redundant services have been identifed in eth pits and removed or marked on the surface Services isolated or deenergised

  • Dial Before you dig
  • VMP in place
  • Parallel and converging services have been located
  • Plan identifies all burined, concealed and overhead services
  • Services have been isloated
  • Hydro-vacuum
  • Hand digging
  • Electronic detection GPR scanning comppleted and all services burried or concealed clearly marked
  • Pot holing / slit trenching intervals defined
  • Plant wheel loading considered
  • Emergency Response and Rescue Plan approved
  • Contaminated ares controlled
  • Calibrated GPR wands in good condition
  • Survey of area completed
  • Hydro excavation is limited to no no more than 13800kpa/2000psi
  • Hard surfaces have been removed to conduct pot holing
  • All known redundant services have been identifed in eth pits and removed or marked on the surface
  • Services isolated or deenergised

• Have the services locations and their depth or height (as applicable) also been identified on plans and drawings ?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Have all redundant Services been marked?

• Have all associated nearby pits been opened, and checked to identify services?

  Yes

  No

  N/A

• Prior to commencement of mechanical excavation or penetration the Permit has been approved and issued?

• Has a daily inspection been completed by the Permit Holder for this work and activity?

  Yes

  No

  N/A

• What controls were verified at the work front?

  Select Non-destuctive excavations have been conduicted prior to excavations All known services have been physically identifed prior to excavations Operator understands the safe approach distances to be observed All pit lids have been removed in area and redundant services identified or removed A search for new area for services has included a walk through the area to identify signs of other services i.e. disruptions in pavements

  • Non-destuctive excavations have been conduicted prior to excavations
  • All known services have been physically identifed prior to excavations
  • Operator understands the safe approach distances to be observed
  • All pit lids have been removed in area and redundant services identified or removed
  • A search for new area for services has included a walk through the area to identify signs of other services i.e. disruptions in pavements

• Permit Holder to sign to say they have completed an inspection.

  Sign

• Are personnel aware of the how the Safe Approach Distances relevant to the voltage of the service are selected?

  Yes

  No

  N/A
Action required?

• Action

• Allocated to

• Action due

  Date

• Lead Inspector to sign

  Sign

• Other members of the inspection team to sign:

  Sign

• Yes

  No

  N/A