PC HS 09 1 - Red Permit to Break Ground

• Site

  Select

• Permit Number

• Completed by:

• Trade-Contractor

• Permit Issued to (Responsible Person):

• Permit Validity ( 5 Days ) No weekend working around services - From:

• Until:

• Safe System of Work Name and Number:

Part 1

• Location, Extent of Permit & Brief Description of Work (Work zone to be clearly marked on a drawing)

Part 2

• MASTER DRAWING - The following known services have been identified in the master drawing - ( Utility drawing / GPRS not to be older that 6 months )

  Select Underground Electrical Gas Water Telecom Surface/Sewer Overhead Electrical Other (state)

  • Underground Electrical
  • Gas
  • Water
  • Telecom
  • Surface/Sewer
  • Overhead Electrical
  • Other (state)

Part 3 - Control Checks

• Has the relevant work area been visually surveyed and fully scanned using scanning equipment including signal generator (all modes) minimum eCAT4+

  Yes

  No

  N/A

• Serial Number

• Calibration Date

  Date

• All modes used?

  Yes

  No

• Scanning Completed by? (Have they been trained in use of the CAT & Genny?)

• Have the locations of all identified utilities been physically marked on the ground ?

  Yes

  No

  N/A

• Has the scanning equipment identified the location of any uncharted utilities?

  Yes

  No

  N/A

• If no utilities have been located, shown on drawings or there is no evidence proceed to Green Permit but proceed with caution scanning the ground every 300mm.

• Has the correct PPE i.e. Flame retardant coveralls/gloves and electrically insulated tools been issued as per risk assessment?

  Yes

  No

  N/A

• Have any isolations requested been granted and in place ( Copy of isolation certificate required / or physical proof )

  Yes

  No

  N/A

• Details of Confirmation

• Has the work area been suitably segregated?

  Yes

  No

• Is support and protection equipment available if services are to be exposed over a considerable distance?

  Yes

  No

• Items Issued:

• Has a colour drawing / sketch of services with physical reference points noting the trial hole / slit trenches been prepared and attached to this permit

  Yes

  No

4 Site Manager / Supervisor & Responsible Person Acceptance

• To be completed By the Responsible Person to confirm that the aforementioned sketches and controls have been accepted:

• Site Manager / Supervisor

  Sign

• Responsible Person

  Sign

5 Briefing by Responsible Person to Dig Team

• To be signed by all personnel involved in undertaking the works to confirm understanding of:
  
  1 Safe System of Work and associated risk assessment.
  
  2 The aforementioned sketch and controls.
  
  3 Prohibition on the use of mechanical plant/equipment with this permit unless it is non-contact i.e. vacuum excavation or hand digging using insulated tools / equipment
  
  4 If trial hole / slit trench has to go through tarmac / concrete where it is not 500mm below the surface then following the marking out of the existing services on the ground a minimum of 500mm away from the service/s a saw cut can be made which will allow tunnelling in from the side.
  
  5 If trial hole / slit trench is of considerable depth which would require the area to be stepped to provide safe access and also support during the works please STOP work and move to a Green permit.

• NOTE: ALL UTILITIES MUST BE TREATED AS LIVE – IF YOU ENCOUNTER HARD SURFACES, SUCH AS CONCRETE, STOP WORK IMMEDIATELY AND SEEK FURTHER ADVICE FROM YOUR SITE MANAGER / SUPERVISOR

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

6 Daily Compliance Check by Site Manager / Supervisor

• Date, Time and Initials (in notes)

  Date

• Date, Time and Initials (in notes)

  Date

• Date, Time and Initials (in notes)

  Date

• Date, Time and Initials (in notes)

  Date

• Date, Time and Initials (in notes)

  Date

• Date, Time and Initials (in notes)

  Date

• Date, Time and Initials (in notes)

  Date

7 Completion Checks

• Trial Hole 1

  Yes

  No

• Trial Hole 2

  Yes

  No

• Trial Hole 3

  Yes

  No

• Trial Hole 4

  Yes

  No

• Trial Hole 5

  Yes

  No

• Have all the trial holes / slit trenches located the known services which were highlighted in Section 1&2?

  Yes

  No

• What has been done to prove that there are no services in the line of the proposed excavation?

• Have all the services found been surveyed and plotted on an As-built?

8 Dig team carrying out the work must inform the site manager / supervisor of any additional findings or variances

• Additional Findings - not shown on, or variances relating to, the service(s) sketches:

9 Site Manager / Supervisor Confirmation that the mast drawing(s) has been updated with co-ordinates/depth

• Site Manager / Supervisor

  Sign

Cancellation

• The works have been completed/stopped and this Permit is cancelled

• Site manager / Supervisor

  Sign