Permit to dig / break ground vr1

• PTW #

• Contract #:

• Project:

• What3Words:

• Site Manager Present:

• PTW Issued by:

• Area

• Task or activity description

• Person in charge of works

• Permit issued on, Valid for 7 days.

  Date

Pre checks, RAMS detailing the following

• Hazards, sequence and method of work

  Yes

  No

  N/A

• Plant, materials and equipment to be used

  Yes

  No

  N/A

• Equipment or method to support / protect excavation

  Yes

  No

  N/A

• Safe access and egress

  Yes

  No

  N/A

• Identification / protection of services

  Yes

  No

  N/A

• Edge protection / demarcation

  Yes

  No

  N/A

• Competent person who will inspect the excavation daily

  Yes

  No

  N/A

Safe system of work

• Service drawings present on site and current

  Yes

  No

  N/A

• Are trial holes required

  Yes

  No

  N/A

• where?

• how many?

• Has the area been CAT scanned

  Yes

  No

  N/A

• Are CAT and Genny present on site

  Yes

  No

  N/A

• Are CAT and Genny calibrated and used by a trained person

  Yes

  No

  N/A

• Are overhead cables present

  Yes

  No

  N/A

• Work in the vicinity of overhead cables to be undertaken in accordance with HSE guidance GS6

  Yes

  No

  N/A

• Work in the vicinity of Underground services to be undertaken in line with HSE guidance HSG47

  Yes

  No

  N/A

• Underground electric cables present

• Underground Gas pipes present

• Underground Water pipes present (potable)

• Sewers and drainage present

• Telecoms ducts present (Openreach/ Virgin/Fibre optic)

• Has a briefing been issued to all individuals carrying out the specified works

• Known services located and marked / protected

  Yes

  No

  N/A

• Any further information required from the service provider

• Will works be undertaken within 500mm of known services, if so NO MECHANICAL DIGGING

  Yes

  No

  N/A

• All hand tools to have insulated shafts

• Supervisor to confirm he is aware that a photograph must be taken prior to any backfilling, with details of location, depth, protection and any unknown services.

  Media

• Any service damage to be reported to main contractor

  Yes

  No

  N/A

Work Area

• Photo of service drawings

  Media

• Image of work area from site plan

  Media

• Photo of work area on site

  Media

Authorisation

• Supervisor. I can confirm that all equipment listed above is available at the workplace, has current certification and that method of work detailed in the risk assessment/ method statement will be followed. All individuals associated with these works have been briefed and are deemed competent to carry out these works

  Sign

• Individuals carrying out the works. I can confirm that I have been briefed on the task, have signed all relevant Risk assessments/Method statements and hold the required competancies to carry out the tasks safely

  Sign

Close out

• Supervisor. I can confirm that all works specified have been completed. The work area and adjacent areas which may have been affected were inspected at the time of completeion and in line with requirements

  Sign