V-HSF035 Permit To Break Ground Rev 001

IMPORTANT NOTICE: You must complete a CAT scan even if a service drawing states there are no services, they are marked as redundant/disconnected or if a client or service provider/s states they are no services or they have been disconnected. If a signal is detected no matter how weak you must stop immediately and inform Ventry Site Management.

• Project Name and Number

  Select

• Subcontractor

• RAMS Ref.

• Classification. Green = Low risk, minimal services all clearly identified and located. Amber = high risk, lots of services, poor weather, out of hours, high voltage etc. Red = very high risk, public domain, significant effect to others. Planning meeting required.

  Red

  Amber

  Green

• Permit No.

• This permit is valid from

  Date

• This permit is valid to

  Date

• Works Description (must state excavation method)

• How will services be visually identified on site?

• Intended mechanical excavation equipment:

• Attached Drawings (Number)

• Attached Drawings Issued By (Name)

• Do utility plans identify any known services in the work area?

  Yes

  No

  N/A

• Have buried service locations been confirmed via scanning and marked on existing plans?

  Yes

  No

  N/A

• Have all buried services in the work area been marked with utility marking paint?

  Yes

  No

  N/A

• Have all existing services been isolated (where possible) and a certificate issued?

  Yes

  No

  N/A

CAT & Signal Generator Competency - Operatives responsible for utility scanning on site must be listed in the section below. If a different person will be completing progressive utility scans during excavation works, they must be clearly listed below.

• Name of CAT & Genny Surveyor - Stage 1

• Name of CAT & Genny Surveyor - Stages 2 &3

• Type of CAT & Genny Equipment - Stage 1

• Type of CAT & Genny Equipment - Stages 2 &3

• Details of Operator Training - Stage 1

• Details of Operator Training - Stages 2 & 3

• CAT & Genny Serial Number - Stage 1

• CAT & Genny Serial Number - Stages 2 & 3

• CAT & Genny Calibration Date - Stage 1

  Date

• CAT & Genny Calibration Date - Stages 2 & 3

  Date

Hold Point: Ventry Manager must visually check the area to ensure:

• Known buried service locations are clearly marked with utility marking paint

  Media

Stage 1 - Authorisation

• Ventry Authorisation - Permit must be authorised by a Ventry Manager after these checks have been completed

  Sign

• Are there any known services within a 5 meter radius of the work area?

  Yes

  No

  N/A

• If No, provide detail/reason as to why there are no known services

Records Of Services

• Foul Sewer

  Select Present Absent Checked Attached Marked

  • Present
  • Absent
  • Checked
  • Attached
  • Marked

• Surface Water

  Select Present Absent Checked Attached Marked

  • Present
  • Absent
  • Checked
  • Attached
  • Marked

• Water Mains

  Select Present Absent Checked Attached Marked

  • Present
  • Absent
  • Checked
  • Attached
  • Marked

• Gas Main

  Select Present Absent Checked Attached Marked

  • Present
  • Absent
  • Checked
  • Attached
  • Marked

• Electricity Cables

  Select Present Absent Checked Attached Marked

  • Present
  • Absent
  • Checked
  • Attached
  • Marked

• Other/Unidentified/Unclear

  Select Present Absent Checked Attached Marked

  • Present
  • Absent
  • Checked
  • Attached
  • Marked

• Have all known services within a 5 meter radius been marked on the attached drawings, and traced and marked on site?

  Yes

  No

  N/A

• Has vacuum excavation been authorised for trial holes?

  Yes

  No

  N/A

• Number, Location and Frequency of trial holes

Hold Point: Ventry Manager must visually check the area to ensure:

• Trial hole locations are clearly marked

  Yes

  No

  N/A

• Utility detection equipment is available on site

  Yes

  No

  N/A

• Exposed services in trial holes are protected (split duct, timber board etc)

  Yes

  No

  N/A

Stage 2 - Authorisation. At this stage you are permitted to excavate trial holes by hand to locate any known buried services. NO MECHANICAL EXCAVATION ALLOWED AT THIS POINT (except vacuum excavation if marked above).

• Permit must be authorised by the Ventry manager responsible for the full duration this excavation work. Only authorised to proceed to Stage 3 once the above checks have been completed and checked

  Sign

• Contractor Acceptance (Subcontractor works supervisor). - I confirm that the precautions specified above will be complied with. - I will ensure the the persons carrying out the work have been briefed, understand, and comply with the safe method of work. - Permit must be accepted by the Subcontractor supervisor/manager responsible for the full duration of this excavation work.

  Sign

• Have agreed protective measures been taken to all known services?

  Yes

  No

  N/A

• Have exposed services been adequately identified, supported and protected?

  Yes

  No

  N/A

• On completion of all above checks being completed, is the intended mechanical excavating equipment the most suitable and safe option for the task?

  Yes

  No

  N/A

Stage 3 - Authorisation. Excavation by mechanical means may proceed providing the following precautions are observed. No mechanical excavation within 0.5m of any known service or as stated within this permit. Progressive utility scan must be undertaken every 300mm excavation depth, the person responsible for this utility scan must be listed in Section 1 of this permit.

• Permit must be authorised by a Ventry manager after these checks have been completed

  Sign

• Checked:

  Red

  Amber

  Green

• Contractor Acceptance (to be signed by subcontractor works supervisor, operatives and banksman). - I confirm that the precautions specified above will be complied with. - I will ensure that the persons carrying out the work have been briefed, understand, and comply with the safe method of work. - Permit must be accepted by the Subcontractor supervisor/manager responsible for the full duration of this excavation works.

• Supervisor/Manager

  Sign

• Banksman

  Sign

• Plant Operator

  Sign

• Operative 1

  Sign

• Operative 2

  Sign

• Start Time

  Date

• Finish Time

  Date

• Authorised By Ventry

  Sign

• Start Time

  Date

• Finish Time

  Date

• Authorised By Ventry

  Sign

• Start Time

  Date

• Finish Time

  Date

• Authorised By Ventry

  Sign

• Start Time

  Date

• Finish Time

  Date

• Authorised By Ventry

  Sign

• Ventry Permit Cancellation - All copies of this permit are hereby cancelled. The work has been completed and the work area if left in a safe condition.

  Sign

• Contractor Acceptance (subcontractor works supervisor). I can confirm that the work for which this permit was issued is now complete. All operatives under my control have been withdrawn, and tools/materials removed from the work area. All barriers and any protection measures have been replaced and area left safe/reinstated.

  Sign

• Show plan details (including known services), setting out details and trench details as applicable.

  Media

• Completed By:

  Sign

• I can confirm that I have checked the work being carried out as described on this permit and I am satisfied that it is being carried out in compliance with the permit requirements. (Checks must be made at least once per shift).

  Yes

  No

  N/A

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