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FM 029 Permit To Dig

The permit outlines the health and safety precautions and procedures required before digging can commence at a specified location and time, including checking for underground services, implementing isolation measures, having an appropriate risk assessment, and confirming all involved parties accept responsibility once the work is authorized. Upon completion, the receiver and issuer must sign off to close out the permit.

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72 views1 page

FM 029 Permit To Dig

The permit outlines the health and safety precautions and procedures required before digging can commence at a specified location and time, including checking for underground services, implementing isolation measures, having an appropriate risk assessment, and confirming all involved parties accept responsibility once the work is authorized. Upon completion, the receiver and issuer must sign off to close out the permit.

Uploaded by

ums6120
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Form 029 Rev No.

01
PERMIT TO DIG
Rev date:
Page 1 of 1
27/11/2018
Section 1- General Information Permit Number:_____________________

Project Name:
Location of Works: Gridlines if Known
Description of Works/Depth/Known
Services etc:
Contractor/Person requesting permit:
Specific Tools/Equipment:
Date & Time: Date: Time:
Duration of Permit:
Section 2- Precaution Checklist

Question Yes No Comment


Are you qualified/trained to undertake this work? CSCS, LUGS Training. STOP AND CHECK
Are tools & Equipment safe and suitable for works?
Has the proposed dig area been scanned and surveyed for presence of existing services?
Has all services noted been located, marked and communicated to all staff involved in dig
Have services been isolated/diverted or disconnected prior to works?
Is there a SSWP/RAMS in place for this task and has a risk assessment been carried out and
adequate control measures actioned? STOP AND CHECK
Will suitable access point, barriers, guardrails, signage be put in place?
Are there any overhead power lines in the vicinity of works?
Are all service isolation valves/switch known?
Are there suitable emergency plans in place prior to works?
Are there suitable shoring/battering/tenchbox provisions in place?
No Mechanical digging within 0.5 metre of a Known live service? STOP AND CHECK HOLD POINT
Is hand digging/trial holes required for this trench/Excavation? STOP AND CHECK HOLD POINT
Correct Selection of bucket as required? Toothless etc; STOP AND CHECK
Spotter/Banksman in place while digging progresses?
Section 3- Authorisation and Acceptance

I confirm that I have verified the above information and ensured that the necessary precautions have been taken. It is
safe to carry out work as defined and the permit information has been explained to all works involved. I accept
responsibility for these works.
Permit Receiver (BLOCK CAPITALS)
Signature:
Company:
Permit Issuer (BLOCK CAPITALS)
Signature:
Company:
Consultation with Client Is coordination required with Client/Local Authority on this particular service?
Y/N
Section 4- Completion/Cancellation/Close Out

I confirm that the work has been completed/partially completed, checked and the area has been left safe and tidy
Permit Receiver: Print: Sign:

Time: Date and Time:

Permit Issuer: Print: Sign:

Time: Date and Time:

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