Campus Infrastructure & Services
CIS STANDARD – PERMIT TO DIG FORM (CIS-ENG-F003)
Project Name
Permit Number
Description and Location of
Works
(drawings, building, dimensions, depths, etc)
University Project Manager (Authorised Person):
Tel:
Mob:
Email:
Mob:
Email:
Head Contractor’s Supervisor:
Tel:
PART A: Must be completed for ALL excavation operations
Has Dial-Before-You-Dig been contacted to identify subsurface utility infrastructure?
Yes/No
Has University infrastructure information been obtained from the University Project Manager and reviewed? Yes/No
Are there known/surveyed underground services in the location?
Yes/No
Electricity Low Voltage
Yes/No
Electricity High Voltage
Yes/No
Gas
Yes/No
Water
Yes/No
Stormwater
Yes/No
Sewerage
Yes/No
Telecom
Yes/No
Fibre Optic
Yes/No
Traffic Signal
Yes/No
Street Lighting
Yes/No
Unknown (detected on Ground
Penetrating Radar, GPR) Yes/No
No services
Yes/No
Proceed with mechanical excavation if no services are indicated within 500mm of the dig area on drawings, GPR survey or
CAT & Genny scans, and the area has been proven clear by Cable Avoidance Tools (CAT) scan. GO TO PART B.
Have all known services been marked out on the ground
Yes/No
WARNING!
1)
2)
3)
If electricity, gas or unknown services are present then carefully expose the subsurface utility or service by pothole
excavation using hand digging or sensitive vacuum/water blasting. Mark verified services on drawings to show
exact depth, location and direction.
Concrete encased electricity or gas services MUST be diverted or isolated before excavating. If not, then
confirmation to proceed with mechanical excavation MUST be obtained from the University Project Manager.
The project’s Head Contractor’s Supervisor MUST oversee all potholing or vacuum/water blasting operations until
the service is safely located.
Have potholes been dug prior to this permit?
Yes/No
Show all known/surveyed services on attached sketches or relevant survey drawings and show all proposed pothole
locations for confirmation of electricity, gas or unknown services.
Provide Safe Work Method Statement specifying equipment to be used to safely expose and identify any underground
service:
PART A: Signed Authority to safely expose and identify underground services
University Project Manager (Authorised Person):
Date:
Head Contractor Supervisor:
Date:
CIS STANDARD – PERMIT TO DIG FORM (CIS-ENG-003)
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Copy of this permit must be kept by Head Contractor’s Supervisor at the project site
PART B: Must be completed with reference to PART A by the University Project
Manager (Authorised Person) for ALL excavations.
Have all known/surveyed services, been safely located?
Yes/No
Have electricity or gas services been identified within 500mm of the dig area?
Yes/No
If Yes, they MUST be fully exposed before mechanical excavation
Yes/No
Notes/Comments:
Mechanical excavation may only proceed if:
1)
2)
no services are indicated within 500mm of the dig area on drawings, GPR survey or CAT & Genny scans, and the
area has been proven clear by Cable Avoidance Tools (CAT) scan, OR
known services in the proposed dig area have been fully exposed by safe techniques under direct supervision by the
Head Contractor’s Supervisor.
PART B: Signed Approval to Dig
University Project Manager (Authorised Person)
Date:
CIS Grounds Unit Manager
Date:
Valid from:
Valid until:
PART B: Acceptance by Head Contractor Supervisor
Head Contractor Supervisor:
Date:
Confirming contents of this permit are understood and relevant contractor operatives briefed on control measures.
Copy of this permit must be retained by Head Contractor’s Supervisor at the project site
The excavation has been completed and left in a safe condition/superseded by another permit
Head Contractor Supervisor:
Date:
WARNING!
Excavation work must be suspended immediately and site made safe if services are damaged and the incident immediately
reported to the University Project Manager.
Copy of this permit must be kept by Head Contractor’s machine operator performing the excavation.
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PLAN/SECTIONS
Show excavation plan details setting out trench details and include known services. Attach additional sheets as required.
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