Permit for Surface Penetration

• Audit Title

• Client: Hoxton Press / Site: 554003

• Conducted on

  Date

• Prepared by

• Location
  Address

1. Completed By Trade Contractor.

• Detail of work to be carried out,

• Area of site undergoing excavation, reduced level digging or penetration are described by map or drawing to be attached.

Precautions to be taken to avoid danger & damage to buried services such as Radar/CAT/Acoustic Wall Device:

• CAT Scan Carried out:

  Yes

  No

  N/A

• Confirmation that the area to be disturbed has been surveyed. The coordinated drawing is up to date.

  Yes

  No

  N/A

• Are services marked up and do all understand the markings in relation to services ?

  Yes

  No

  N/A

• Has the CAT & GENNY and used in locating services ?

  Yes

  No

  N/A

• Confirm that the operators / Banksman and machine driver have been briefed on services and precautions.

  Yes

  No

  N/A

• ALL operators are aware that they should not deviate from the Method Statement. If services encountered during the works are different ( e.g. Type, location etc ) to those already identified they MUST stop work and consult the supervisor and services coordinator.

  Yes

  No

  N/A

• If using power tools or machinery within 500mm either side of the line of known buried services is unavoidable. Detail the additional control measures to be taken below:

  Yes

  No

  N/A

• Extra detailed control measures if needed:

• Confirm that the service(s) (National Grid, BT etc) emergency contact details are known for immediate communications.

  Yes

  No

  N/A

Trade Contractor Supervisor Confirmation:

• Confirmation that the above items have been discussed with all those concerned and agreed with the information supplied.

  Sign

Driver Confirmation:

• I have discussed and agree with all items above.

  Sign

Banksman Confirmation:

• I have discussed and agree with all items above.

  Sign

2. Services Co-ordinator Confirmation:

• I have discussed and agree with all the items above. All operatives understand the precautions to be taken with the works:

  Sign

3. Permit Closed Out:

• All excavation(s) have been left in a safe and secure manner with appropriate barriers to prevent falls. Signage must be in place. If excavation has been back-filled, that it has the correct identification markings for services and is added to the drawings.

• Photos taken to show exposed services:

  Yes

  No

• Photos taken to show installed marked services:

  Yes

  No

• All information is added to as built drawing:

  Yes

  No

• Wates BSC name:

  Sign

• Contractor Supervisor name:

  Sign