Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
TVA - DRILLING OR CHIPPING IN CONCRETE PERMIT
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Activity:
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Work Location Building / Unit:
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Elevation / Column Line:
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DESCRIPTION: (include exact location and extent of work. Attach sketch as required)
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REFERENCE DRAWINGS REVIEWED: (choose all that apply)
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REFERENCE DRAWINGS REVIEWED: (choose all that apply)
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REFERENCE DRAWINGS REVIEWED: (choose all that apply)
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REFERENCE DRAWINGS REVIEWED: (choose all that apply)
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Any embedded items identified? (If "YES," include Special Precautions)
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Special Precautions Required:
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Any equipment panels, etc. nearby which would indicate embedded conduit exists or special precautions should be imposed: (If "YES, " include Special Precautions)
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Special Precautions Required:
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NOTE: For personnel safety, and equipment damage protection, pachometers, subsurface rebar detectors Evader rebar detecting devices (drill stop devices) are available and shall be used as prescribed below.
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SPECIAL PRECAUTIONS: (NOTE: Notify Unit Operator immediately if damage occurs to service)
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Rebar Protection Device: (If required verify operability prior to drilling)
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If NOT REQUIRED and embedments have been exposed, check for damages.
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Provide Explanation if NOT REQUIRED:
REQUESTED BY
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Select date
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Name / Organization / Telephone#:
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Page Number:
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Hold Order #:
REVIEWED BY
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Electrical Supervisor signature :
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Mechanical/Insteument Supervisor signature :
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Civil Supervisor signature :
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Shift Supervisor signature :
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Plant Representative (Hydro) signature :
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Responsible Engineer signature :
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Responsible Manager Supervisor signature :
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Information Services signature :
WORK COMPLETION
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Foreman signature:
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Responsible Engineer signature:
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(1) Must be foreman, engineer, maintenance planner or supervisor responsible for the work. (2) items considered: Personal safety, no equipment damage, no interface with operating equipment, chemical spills, no adverse effect from dust, vibration, or water from core drilling. (3) for Hydro applications the permit shall be reviewed by the responsible engineer, a plant representative, and the electrical, mechanical and civil engineering supervisors (CE-D engineers).
