Permit to work (Earthwork)

• Project title

• Earthworks reference number

• Location of work
  Address

• Type of earthwork

  Soil investigation works

  Ground Instrument works

  Trial trench works

  Others

• Date

  Date

• I hereby submit this form for clearance prior to proceeding to dig or borehole / trial pit

  Sign

• To attach photo on the the daily checklist

Daily pre-start prior to SHE requirements

Monday

• Date

  Date

• Type of activites

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

Tuesday

• Date

  Date

• Type of activites

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

Wednesday

• Date

  Date

• Type of activites

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

Thursday

• Date

  Date

• Type of activites

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

Friday

• Date

  Date

• Type of activites

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

Saturday

• Date

  Date

• Type of activities

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

Sunday

• Date

  Date

• Type of activites

  Select Hacking / Road cutting Trial trench Manual trial pit Manual hand auger Soil drilling Standard penetrations test Thin wall Mazier sampling Rock coring In situ test Grouting Instrument installation Cone penetrations test General housekeeping

  • Hacking / Road cutting
  • Trial trench
  • Manual trial pit
  • Manual hand auger
  • Soil drilling
  • Standard penetrations test
  • Thin wall
  • Mazier sampling
  • Rock coring
  • In situ test
  • Grouting
  • Instrument installation
  • Cone penetrations test
  • General housekeeping

• Conduct daily JSA / toolbox meeting? (photo of the TBM form)

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest? (photo of workers in full PPE)

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs? (photo of barricaded work area)

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity (photo of CSOC, BCSS, RES & Operator certificate)

  Yes

  No

  N/A

• Method of statement, risk assessment & safe work procedure available on site (photo of documents)

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks? (photo of mechanical equipment used)

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)? (photo of LM cert, LG cert, Monthly maintenance report & Daily checklist by operator)

  Yes

  No

  N/A

• Ground inspections made after every rainstorm or other hazard-increasing<br>occurrence. (photo of equipment & excavated area)

  Yes

  No

  N/A

• Notification of other affected parties undertaken? (photo of letter/email approval)

  Yes

  No

  N/A

• Person In-charge

  Sign

• Verified by SHE personnel

  Sign

SECTION 1: APPLICATION BY PERMIT APPLICANT

• I will commit to be in line with the safety requirements mentioned in the checklist & will not deflect any of them

  Yes

  No

  N/A

• Name

  Sign

• Remarks

SECTION 2: EVALUATION BY PROJECT COORDINATOR

• I have evaluated the hazards and risks associated with the nature of works carried out and all reasonably practicable measures have been taken to ensure the safety and health of the persons who will be carrying out works in the worksite

  Safe

  At Risk

  N/A

• Name

  Sign

• Remarks

SECTION 3: APPROVAL BY PROJECT MANAGER / FIELD MANAGER / OPERATIONS MANAGER

• I am fully satisfied that a thorough inspection and proper assessment of the above have been done by Applicant & Project Coordinator so that works can be carried out safely. I hereby approve the work to commence

  Safe

  At Risk

  N/A

• Name

  Sign

• Remarks

SECTION 4: REVIEWED BY SHE DEPARTMENT

• I am fully satisfied that safety measures are in place and according to procedure by the project team

  Compliant

  Non-Compliant

  N/A

• Name

  Sign

• Remarks

SECTION 5: NOTIFICATION OF COMPLETION/REVOCATION OF PERMIT TO WORK

• Permit status

  Closure for the week

  Completion

  Revocation

• Name

  Sign

• Reinstate the affected work area for the completion of this earthworks

  Good

  Fair

  Poor

  N/A

• Remarks

Compliance to requirements for utility service agencies & other bodies prior to the work activity

• Project Title

• Earthworks reference number

• Photo of utilities drawing to attached for all affected services

NCD

• NCD Date

  Date

Utilities Drawing

SPPG

SPPG High Pressure (gas)

• Distant & direction of service

SPPG Medium Pressure (gas)

• Distant & direction of service

SPPG Low Pressure (gas)

• Distant & direction of service

SPPG Low Voltage (cable)

• Distant & direction of service

SPPG High Voltage (cable)

• Distant & direction of service

SPPG Extra High Voltage (cable)

• Distant & direction of service

SPPG WIP(cable)

• Distant & direction of service

NCE

• Approval

  Yes

  No

  N/A

PUB

Water line

• Distant & direction of service

Sewwer line

• Distant & direction of service

DTSS

• Distant & direction of service

POWS

• Approval

  Yes

  No

  N/A

Telecommunication Services

Singtel

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Starhub

• Distant & direction of service

• NCE

  Yes

  No

  N/A

M1

• Distant & direction of service

• NCE

  Yes

  No

  N/A

SP Telecom

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Netlink

• Distant & direction of service

• NCE

  Yes

  No

  N/A

TATA

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Reach

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Superloop

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Verizon

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Orange

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Telecom Italia Sparkle

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Angora

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Others

Others 01

• Service name

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Others 02

• Service name

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Others 03

• Service name

• Distant & direction of service

• NCE

  Yes

  No

  N/A

Clearances / Temporary Occupation License

• LTA / DBC

  Yes

  No

  N/A

• SLA

  Yes

  No

  N/A

• N Parks

  Yes

  No

  N/A

• Town Council

  Yes

  No

  N/A

• HDB

  Yes

  No

  N/A

• URA

  Yes

  No

  N/A

• JTC

  Yes

  No

  N/A

• NEA

  Yes

  No

  N/A

• PUB

  Yes

  No

  N/A

• PSA

  Yes

  No

  N/A

• MPA

  Yes

  No

  N/A

• Others:

  Yes

  No

  N/A

Verifications by project team

SECTION 1: SUBMITTED BY PERMIT APPLICANT

• I confirm the following locations for earthworks have been studied & checked based on existing utility services drawings & cable detection report

  Yes

  No

  N/A

• Name

  Sign

• Remarks

SECTION 2: VERIFIED BY PROJECT COORDINATOR

• I have verified & ensure all necessary precautions must be taken to safeguard & avoid any damages to utilities services

  Compliant

  Non-Compliant

  N/A

• Name

  Sign

• Remarks

SECTION 3: REVIEWED BY PROJECT MANAGER / FIELD MANAGER / OPERATIONS MANAGER

• I am fully satisfied that a thorough check had been done & all regulatory approvals for the earthworks are in place.

  Compliant

  Non-Compliant

  N/A

• Name

  Sign

• Remarks

SECTION 4: REVIEWED BY SHE DEPARTMENT

• I am fully satisfied, project teams are doing their duties with due diligence to avoid any damages to utilities & approval to relevant parties

  Compliant

  Non-Compliant

  N/A

• Name

  Sign

• Remarks