Permit to work (Earthwork)

• Project title

• Location Of Work & Borehole Reference Number:

• 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

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

• Project Title :

• Location Of Work & Borehole Reference Number:

• NCD Date:

  Date

• Project Coordinator:

  Sign

Utilities Drawing

SPPG

• SPPG High Pressure (gas)

  Yes

  No

  N/A

• SPPG Medium Pressure (gas)

  Yes

  No

  N/A

• SPPG Low Pressure (gas)

  Yes

  No

  N/A

• SPPG Low Voltage (cable)

  Yes

  No

  N/A

• SPPG High Voltage (cable)

  Yes

  No

  N/A

• SPPG Extra High Voltage (cable)

  Yes

  No

  N/A

• SPPG WIP (cable)

  Yes

  No

  N/A

PUB

• Water line

  Yes

  No

  N/A

• Sewer line

  Yes

  No

  N/A

• DTSS

  Yes

  No

  N/A

Telecommunication Services

• Singtel

  Yes

  No

  N/A

• Star hub

  Yes

  No

  N/A

• M1

  Yes

  No

  N/A

• SP Telecom

  Yes

  No

  N/A

• Netlink

  Yes

  No

  N/A

• TATA

  Yes

  No

  N/A

• REACH

  Yes

  No

  N/A

• Superloop

  Yes

  No

  N/A

• Verizon

  Yes

  No

  N/A

• Orange

  Yes

  No

  N/A

• Telecom Italia Sparkle

  Yes

  No

  N/A

• Agora

  Yes

  No

  N/A

• Others

  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

Daily pre-start prior to SHE requirements

Day 1

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

Day 2

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

Day 3

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

Day 4

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

Day 5

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

Day 6

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

Day 7

• Date

  Date

• Conduct daily JSA / toolbox meeting?

  Yes

  No

  N/A

• Worker in full PPE: Safety Shoes, Safety Helmet & Vest?

  Yes

  No

  N/A

• Working area fitted with rigid barricades & warning signs?

  Yes

  No

  N/A

• All personnel are competent / qualified in the work activity

  Yes

  No

  N/A

• Workers understand the sequence of work, safe work procedure & emergency procedures

  Yes

  No

  N/A

• Means of communication between drilling team established

  Yes

  No

  N/A

• Any mechanical equipment used for the earthworks?

  Yes

  No

  N/A

• Equipment inspected & maintained (daily / periodic / 3rd party)?

  Yes

  No

  N/A

• Relevant documents on site? (NCD, NCE, TOL)

  Yes

  No

  N/A

• Notification of other affected parties undertaken?

  Yes

  No

  N/A

• Person In-charge

  Sign

SECTION 1: APPLICATION BY PERMIT APPLICANT

• Following locations for digging / boring have been studied, based on existing utility services drawing(s) available, cable detection & area is safe to work

  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

  Completion

  Revocation

• I have completed the permitted works and have make good the affected work area for the closure of this permit

  Good

  Fair

  Poor

  N/A

• Name

  Sign

• Remarks