Sovereign Construction Limited

• Sovereign Construction - Permit to Work

Application for a Permit to carry out essential works on HHGL Limited T/A Homebase Estates

• The permit must be available at the work site and returned to the authorised site representative on completion of work for sign off and filing. Please print clearly in BLOCK CAPITALS.

• Homebase Site Name

• Site Number

• WON/PO

• Contact Name/Number

  Select Dean Beckenham - 07769 820 352 Kelly Sutherley - 07552 402 250

  • Dean Beckenham - 07769 820 352
  • Kelly Sutherley - 07552 402 250

• Location working on site

  Select Car park Sales floor Warehouse Loading bay Roof area Offices Side of building Front of building Back of building Canteen Toilets Other

  • Car park
  • Sales floor
  • Warehouse
  • Loading bay
  • Roof area
  • Offices
  • Side of building
  • Front of building
  • Back of building
  • Canteen
  • Toilets
  • Other

• Please Specify

• Contact Tel No

• Name of all operatives on site

• Description of work

• Equipment to be used

Contractor to complete the following for all work

• I have read and understood the fire evacuation process for the is building including assembly point and how to raise the alarm

  Yes

  No

• I confirm that I and my team are trained and competent for the work I am to undertake

  Yes

  No

• Work Permits

Contractor to complete the following for all working at height or roof work

• Is a working at height/roof work permit required?

  Yes

  No

• I will ensure that there is safe access and egress before commencing the work

  Yes

  No

  N/A

• I have checked roof plans / risk assessments for fragile surfaces / edge protection and other existing hazards (roof work only)

  Yes

  No

  N/A

• I have confirmed that the weather conditions are suitable for the work I am to undertake (outside work only)

  Yes

  No

  N/A

• I have a suitable rescue plan in place that is trained and understood by all working in my team, this will be amended to suit the needs of the site before works commence

  Yes

  No

  N/A

• I am familiar and competent to use the roof access equipment ie lanyard and all statutory inspections are in date

  Yes

  No

  N/A

• I confirm that suitable barriers will be erected to ensure that nothing can fall onto people / property below the working area

  Yes

  No

  N/A

Contractor to complete for confined spaces

• Is a confined spaces permit required?

  Yes

  No

• I can confirm that checks will be made prior to entry for fumes / flammable atmosphere I-gas

  Yes

  No

  N/A

• I confirm that people attending this job are trained in rescue from confined spaces and before the job commences a rescue plan will be in place

  Yes

  No

  N/A

• I have a suitable means of communication for those in the confined space

  Yes

  No

  N/A

• Contractor to complete the following for electrical work

Contractor to complete the following for electrical work

• Is a Electrical permit required?

  Yes

  No

• I confirm that all apparatus in the area specified is dead, isolated from all live conductors and is connected to earth

  Yes

  No

  N/A

• I have posted warning notices as applicable.

  Yes

  No

  N/A

• State where

• I confirm that I understand general Electrical Safety Procedures and I will follow them whilst working

  Yes

  No

  N/A

• I confirm I have fitted safety locks.

  Yes

  No

  N/A

• State where

Contractor to complete the following for all hot works

• Is a hot works permit required?

  Yes

  No

• I confirm that the work area will be adequately ventilated

  Yes

  No

  N/A

• I have or will make arrangements for the smoke detectors to be isolated in the work area and Impairment Procedures followed and will return them to full service after the works have ceased

  Yes

  No

  N/A

• I will have a minimum of 2 fire extinguishers available in the working area and I am trained in their use

  Yes

  No

  N/A

• I will complete a mandatory fire watch for 60 mins post works

  Yes

  No

  N/A

• I will ensure that all surrounding areas are clear from rubbish, have been swept clean and are free from combustible materials and or are wetted down as appropriate

  Yes

  No

  N/A

• I have confirmed that all stock, plant and machinery within 1 Om (including underneath any mezzanine levels) will be protected from heat and sparks with non-combustible curtains, metal guards or flame proof covers

  Yes

  No

  N/A

• I will ensure that warning notices have been posted as applicable

  Yes

  No

  N/A

Contractor to confirm all hot works have ceased and a fire watch commenced at

• Is fire watch required?

  Yes

  No

• Start of fire watch

• Company

• Position

• Signature

  Sign

• Date & Time

  Date

• Finish of fire watch

• Company

• Position

• Signature

  Sign

• Date & Time

  Date

Contractor to complete the following for all excavations

• Is a excavations permit required?

  Yes

  No

• I confirm that prior to work commencing physical checks will be made for underground services

  Yes

  No

  N/A

• I confirm that I will make provision to prevent people and equipment from falling into any hole / trench and that the area will be securely fenced off

  Yes

  No

  N/A

• I confirm I will make suitable provision to prevent any trench from collapsing

  Yes

  No

  N/A

Additional Hazards Identified with Control Measures Implemented

• Hazard Identified

• Risk

  High

  Medium

  Low

• Control Measures

• Responsibility

• Hazard Identified

• Risk

  High

  Medium

  Low

• Control Measures

• Responsibility

• Hazard Identified

• Risk

  High

  Medium

  Low

• Control Measures

• Responsibility

• Authorisation and Sign off Section

Authorisation by HHGL Limited T/A Homebase Estates (Before Works Start)

• The above work is authorised to proceed on the provision that the procedures above are maintained for the duration of the work and therefore issue any keys or access to required areas.

• Signed

  Sign

• Position

• Before Photos - Minimum of 2

  Media

• After Photos - Minimum of 2

  Media

Contractor Works Completed & Areas Safe

• The work area has been inspected, left clean and tidy and can be signed back into general use. Any keys Issued have been returned.

• Contractor Signed

  Sign

Authorised Completion by HHGL Limited T/A Homebase Estates

• The above works have been completed and any keys issued to required areas, have been returned.

• Signed

  Sign

• Position