DIG PERMIT FORM
The Applicant shall complete sections 1 and 2, sign section 3 and submit to the Maintenance Superintendent for
approval.
The Permit Checklist has been reviewed with the applicant prior to the commencement of work
Use
Permit No.:
EDOC No.:
SECTION 1: GENERAL
Applicant Company:
Phone:
Company performing
works:
Company representative in
charge of works:
Fax:
Phone:
Person in attendance:
Permit Valid From:
Phone:
(Hrs)
Date:
To:
Date:
(Hrs)
SECTION 2: WORK DETAILS, PRECAUTIONS & CONDITIONS
2.1 Description Of Work
Location of Work:
(Specific)
Description of Work:
(type/personnel/equip)
Excavation Details:
A: Depth
B: Width
C: Length
Service Drawing No(s):
Equipment:
Existing Services
identified:
Services to be modified:
2.2 Permit Checklist
Does the work involve:
1. Work with potential to generate heat or spark, (e.g. welding, cutting, grinding,
abrasive blasting etc) result in fire associated with equipment, vessels, or
structures in vicinity incl fire associated with other operations eg bunkering?
2.
Abrasive blasting?
A180410
Y
N
If yes obtain:
Hot Work Permit
DCW / DBLB /
General
Abrasive Blasting
Checklist
Page 1 of 4
DIG PERMIT FORM
3.
4.
5.
6.
Any space not designed for normal work, where rescue may be difficult eg roof
spaces, underneath buildings, within tanks?
High Voltage (HV) incl entry to any signed HV space or cabinet. 240V
electricity which cannot be isolated. Sewer or sewage systems, gas or high
pressure water?
Height greater than 2.4m involving risk of an unrestrained fall or any work at a
height of less than 2.4m involving risk of a fall from one level to another?
Work within 3 m of road within Port and KBIE requiring decreased speed limits
or use of safety barriers or has the potential to impact traffic flow?
7.
All lifts over 20t on DCW or more than 1.5t / m2 on DBLB?
8.
Handling dangerous goods (DG) incl DG transported onto or off land,
transported onto DCW or DBLB, loaded onto or off vessels, or in transit on
vessels in Port?
Removal of native vegetation, work in or near a previously undisturbed area or
within a National Heritage Listed area?
9.
Confined Space
Permit
Services Permit
Working at
Heights Permit
Traffic Permit
Heavy Lift
Permit
Dangerous
Goods Permit
Environment and
Heritage Permit
Diving Permit
10. Diving within 200m of wharf facilities - DBLB, DCW, ALF, HLO, Barge Ramp?
Oversized Load
Permit
11. Loads greater than 4.3m high, 2.4m wide, 19m long or over 42.5t?
2.3 Permit Conditions
Y
1.
Fire Extinguisher is to be on standby at all times.
2.
If required, a fire watch has been organised, fire equipment laid out ready for
use, or the fire pump or fire brigade is on standby.
Hoses, electrical leads and equipment have been tested/tagged in accordance
with Australian Standards.
The Company representative in charge of works / person in attendance agrees
to advise all team members of Permit Conditions.
Natural Area Disturbance Permit has been obtained for excavation in previously
undisturbed area.
Barricades and warning signage are to be in place at all times.
3.
4.
5.
6.
7.
8.
Fire extinguisher is to be on standby at all times when operating machinery near
vegetation.
Cable indicator is to be used to locate existing services.
9.
Spotters are to be used when excavating using machinery.
10.
Hand excavation is to be used around existing services.
11.
Existing services drawings are to be marked up prior to commencement of work
and displayed on site.
The Company representative in charge of works / person in attendance agrees
to advise all team members of Permit Conditions.
Other conditions / precautions.
12.
13.
A180410
N
Page 2 of 4
N/A
DIG PERMIT FORM
2.4 Required Permit Documentation
Y
1.
JHA / JSA / JSEA / WMS / SWI.
2.
Site drawing outlining location work works.
3.
Utility providers’ “Dial before you Dig” information.
N
N/A
SECTION 3: Receipt, Permit Approval & Permit Acceptance
If the Applicant is the Company which will carry out the work, by applying for this permit it makes the following warranties,
undertakings and acknowledgements:
1. The Applicant warrants that it understands the nature of the work permitted by the permit and risks associated
with it, has sufficient competence to carry out the work and accepts responsibility (including occupational health
and safety responsibility) for the work.
2. The Applicant undertakes to notify DPA as soon as possible after it identifies any issue which would prevent the
work from being carried out safely, and to liaise with DPA to allow the work to be carried out safely.
3. The Applicant acknowledges that the issuing of this permit does not constitute approval by the DPA of the work
or occupational health and safety procedures in relation to the carrying out of the work.
4. The Applicant warrants that, where it has particular expertise or technical knowledge with respect to the work
permitted by the permit, it accepts that it, and not DPA, exercises control over that work and is responsible for
any occupational health and safety obligations arising from that work.
If the Applicant is not the Company which will carry out the work, by applying for this permit it makes the following
warranties, undertakings and acknowledgements:
1. The Applicant warrants that it understands the nature of the work and risks associated with it.
2. The Applicant undertakes to take whatever steps are required to ensure that the Company which will carry out
the work understands the nature of the work and risks associated with it.
3. The Applicant warrants that the Company which will carry out the work has sufficient competence to carry out the
work and accepts responsibility (including occupational health and safety responsibility for the work.
4. The Applicant undertakes to take whatever steps are required to ensure the Company which will carry out the
work notifies the DPA as soon as possible after it identifies any issue which would prevent the work from being
carried out safely and liaises with the DPA to allow the work to be carried out safely.
5. The Applicant undertakes to take whatever steps are required to ensure the Company which will carry out the
work understands that the issuing of this permit does not constitute approval by the DPA of the work or
occupational health and safety procedures in relation to the carrying out of the work.
Applicant’s Authorised Representative:
(Name)
(Signature)
(Date)
(Signature)
(Date)
(Title)
Permit Authoriser:
(Name)
Notifications:
Wharf Manager Y
N
Environment Y
N
Safety Y
N
Maintenance Y
N
Engineering Y
N
Security Y
N
A180410
Other:
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DIG PERMIT FORM
SECTION 4: Completion
The work has been completed and all persons who had a role in carrying out the work, materials and equipment have
been withdrawn.
Authorised Representative of Applicant Signed
(Name)
OR
Company in Charge of Works Signed
(Signature)
(Date)
Permit Authoriser:
(Signature)
A180410
(Date)
Page 4 of 4