PC HS 23 2 - Green Permit Mechanical Excavation

• Site

  Select

• Permit Number

• Permit Completed By:

• Permit Issued To (Responsible Person):

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

• Until:

• Safe System of Work Name and Number:

• Task

Part 1

• Location, Extent of Permit & Brief Description of Work

Part 2

• Master Drawing : The following services have been identified in the master drawing

  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 Red Hand Dig Permit been completed for the area of works concerned?

  Yes

  No

  N/A

• Details of Permit

• Why (i.e. green field site no services shown on an information provided)

• Is mechanical excavation required to step the sides to provide safe access and ground support for trial hole works?

  Yes

  No

  N/A

• Explain what has been done so far

• Has the ground been marked to show the extent of the areas where mechanical excavation is not allowed? Example below

  Yes

  No

  N/A

• Provide photograph of the area

  Media

• 

• Have any new services been installed on the site?

  Yes

  No

  N/A

• Revert back to the Red Permit

• Is there suitable fencing in place to secure the working area?

  Yes

  No

  N/A

Site Manager / Supervisor & Responsible Person Acceptance

• To be completed by Foreman/Supervisor to confirm that the aforementioned sketches and controls have been accepted:

• Foreman / Supervisor

  Sign

• Foreman / Supervisor

  Sign

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
  
  2 The aforementioned sketch and controls.
  
  3 Prohibition on the use of mechanical plant/equipment within 500mm of the located services

• 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 SUPERVISOR

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

• Name of Employee

  Sign

PERSONNEL 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:

CANCELLATION

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

• Site Manager/Supervisor

  Sign