Annex Z to LUES H&S Policy
Estates Services
Safe Systems of Work and Permits
Compliance with this policy and guidance is mandatory for all work that is
undertaken by Estates Services Staff and Contractors working in areas being
managed by or under Estates Services Control. Where work is undertaken in areas
not under Estates Services direct control, those managing or undertaking the work
shall adopt equivalent and approved safe systems of work. Such alternative
arrangements should be agreed in writing by the Estates Services
Manager/Supervising Officer responsible for the work.
This policy and guidance should be read in conjunction with the specific policy
document for the work it applies to as contained within University and Estates
Services Health and Safety Policies, Codes of Practice and guidance.
This guidance should be read in conjunction with Appendix 5 to Annex G “Working
with Contractors Guide”.
Guidelines adopted.
The following guidelines form the basis of this policy covering safe systems of work
and access. Following a consultation exercise with various stakeholders, this policy
was ratified at the December 2005 Estates H&S Committee meeting.
-
The permits are aimed at achieving a common approach to all Estates work
across campus and form part of safe systems of work.
-
Permits must not to be considered as an alternative to adequate supervision
and management but an integral part of the management process.
-
Permits should reflect the level of risk and must not be utilised for low risk work
lest their effectiveness be devalued.
-
The safe systems of work and permits contained within this policy should be
utilised with immediate effect, with any modifications recommended by the
Departmental Health and Safety Committee or following audit/revue
incorporated as necessary on an ongoing basis.
-
Nominated duty holders for particular safe systems will authorise and issue
access authorities and permits as appropriate. These have been indicated in
their respective permit sections and generally mirror current duty holders and
nominated authorities with some titles changed to incorporate new posts
created in the 1995 Estates Review.
Training
The majority of the permits have been utilised in a slightly different format for many
years. Suitable training will be arranged as necessary via extended office talk
sessions, toolbox talks and equivalent, as appropriate to section requirements.
Should a requirement for formal presentation be identified.
Communication to other stakeholders.
-
All permits shall be recorded using serial numbered duplicate, triplicate or
quadruplicate copies as appropriate with one copy retained in the permit record
book by the duty holder. Further copies may be made and distributed by
individual Project Managers/Supervising Officers/Supervisors/Duty holders as
deemed necessary with a note made on the retained copy.
-
Copies of specific permits should be forwarded to the Development Section by
Maintenance and vice-versa with a central copy being held by the helpdesk.
(See individual permits).
-
Where copies of permits are sent to Supervisors, they shall be routed via the
Estates Services Helpdesk for incorporation onto a permits database prior to
forwarding.
-
Permits should be cross-referenced to numbered ‘Caution Notices’ where
isolation is required as a formal part of the safe system of work.
-
Copy distribution and colour coding:
The following colour coding shall be adopted for multi copy permits:
Top Copy – Issued to Operative – White
Second Copy – Issued to relevant Maintenance Supervisor/Helpdesk –
yellow.
Third Copy – Issued to Maintenance/Development Section– Pink
Original – retained in permit book – light blue.
-
NB. The original copy will be the only one to incorporate the permit cancellation
section as appropriate.
-
Each permit will be serial numbered and the book will become an accountable
document once started.
-
Spoiled permits should be destroyed and a note made on the retained copy.
-
Used permit books should be returned to the helpdesk for retention.
The Helpdesk should be notified when specified permits1 are cancelled so that
they are able to undertake checks and audits in an effort to assist project
managers manage their permits.
Contractors’ Signing in Book – maintained by Estates Helpdesk and
Development Unit
The contractors signing in book should also be used for contractors to sign out
daily on works completion. One contractors’ signing in/out book shall be
maintained at the Helpdesk and one at the Development Unit. Other than these
two locations, only ring fenced CDM contracts will utilise further signing in/out
books., Contractors should be instructed to sign in before works commencement
and out at the end of each job or the working day (whichever is soonest) unless
recorded alternative arrangements had been made to cover early starts, weekend
working etc...
Contractors’ and Staff Handbooks – maintained by the Development Section
Health and Safety Coordinator and the Departmental Health, Safety and
Sustainability Coordinator.
This policy should be read in conjunction with the existing notes that are issued to
Contractors and Direct Labour staff as part of their induction training.
1
Specified permits requiring copies to Helpdesk are:
Low Voltage Electrical Permit
High Voltage Electrical Permit
Access to controlled areas
Confined Spaces
Pressure Systems
Key and Work Authority Estates Controlled Areas: (Appendix 1).
Triplicate Book
Duty holder: Maintenance Engineer, Maintenance Officer, Development
Engineer, University Surveyor or their nominated deputies plus anyone
authorised in writing by the Director of Estates Services.
This authority is to be used as a key authorisation note for accessing technical
areas, plantrooms, boiler rooms, roofs, technical spaces, confined spaces etc. for
which Estates Services are duty holders.
Duty holders should ensure that any deputies that they authorise have sufficient
knowledge of the hazards associated with the area before nominating them as
deputies.
The form may be utilised as a form of authority to work as required by managers
and supervisors who wish to reinforce any verbal agreements for specific risks that
may arise from time to time that are not covered by other permits.
Where this authority is issued in association with other permits, (e.g. void or roof
access), the reference number of the permit and its type should be inserted in
Section 2 ‘Other precautions or special conditions or additional permits’.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person
1st Copy (Yellow) – Helpdesk
Bottom Copy (Light Blue) – To be retained in permit book
Fire Alarm Isolation Request: (Appendix 2).
Triplicate Book
Duty holder: Maintenance Engineer, Maintenance Officer, University
Surveyor, Development Engineer, Assistant Building Surveyor or their
nominated deputies plus anyone authorised in writing by the Director of
Estates Services.
The form at Appendix 2 should be used by anyone managing works where fumes
or dust might be produced and where the assistance of the engineers, electricians
or electrical contractors was required to isolate alarms.
The use of this document would also serve as a reminder where sensors and
detectors had been temporarily bagged to be re-enabled following works.
It should be noted that the person authorising a significant isolation of an automatic
Fire alarm/detection system should inform the University’s Insurers on the
appropriate form.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person.
1st Copy (Yellow) – Helpdesk.
Bottom Copy (Light Blue) – To be retained in permit book.
Electrical Low Voltage Permit to Work/Test2. (Appendix 3).
Quadruplicate Book
Duty holder: Maintenance Engineer, Senior Authorised Person and his
nominated deputies plus Authorised Persons electrical.
The permit at Appendix 3 is to be utilised for all work on the low voltage systems
other than work agreed by nominated deputies, who may allow suitable, competent
electrical contracts managers to discharge this duty on their behalf and simple
local maintenance works like single sockets and light switches undertaken by
competent electricians.
Part 1 Should be completed by the Estates Services Duty Holder responsible for
the work. Where the person authorising the work is also responsible for the
switching etc, they may issue this permit to themselves as a check on procedures.
The apparatus is to be disconnected from all live conductors before work
commences.
Part 2 Should be complete by the Estates Services Duty Holder who is responsible
for switching, isolating, testing and earthing operations prior to issuing the permit
and work commencement.
2
Please route a copy via Helpdesk and inform them when the permit is cancelled.
Part 3 Should be signed by the Competent Person actually in charge of the work
on the apparatus. The original should be retained by the Competent Person
actually in charge of the work until the work is stopped or completed. One copy
should be retained in the book by the person authorising the work.
Part 4 Should be signed by the Competent Person actually in charge of the work
when the work has been stopped or completed and the handed back to the person
who authorised the work.
Part 5 Should be signed by the Estates Services Duty Holder responsible for
signing Part 2, or in his/her unavoidable absence, by a person of equivalent status
and who has knowledge of the work.
A Switching Schedule (Appendix 5) may be completed and incorporated in Low
Voltage Electrical permits as appropriate as an accountable document for all
complicated Switching and permitted work and used as an aid memoir during the
switching process.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person undertaking/in charge of the work.
2nd Copy (Yellow) – To Estates Services Electrician via Estates Helpdesk.
3rd Copy (Pink) – Development or Maintenance as appropriate.
4th Copy (Bottom copy) – Retained in permit book as an accountable document.
Electrical High Voltage Permit to Work/Test3. (Appendix 4).
Quadruplicate Book.
Duty holder: Senior Authorised Person or Authorised Persons electrical
only.
The High Voltage Electrical permit shall be utilised for access to all substations and
all high voltage electrical work.
Part 1 Should be completed by the Authorised Person responsible for the
switching, isolation, testing and earthing operations and issued to the person
responsible for carrying out the work. Where the person authorising the work is
also responsible for the switching etc, they should issue this permit to themselves
as a check on procedures.
3
Ditto
Part 2 Should be completed and signed by the Authorised Person responsible for
switching, isolating, testing and earthing operations after their completion.
Part 3 Should be signed by the Competent Person actually in charge of the work
on the apparatus. The original (top copy) should be retained by the Competent
Person actually in charge of the work until the work is stopped or completed. The
bottom copy should be retained in the permit book by the person authorising the
work. See also below.
Part 4 Should be signed by the Competent Person actually in charge of the work
when the work has been stopped or completed and the handed back to the person
who authorised the work.
Part 5 Should be signed by the Authorised Person responsible for signing Part 2,
or in his/her unavoidable absences, by a person of equivalent electrical authority
who has thorough knowledge of the work.
A Switching Schedule (Appendix 5) must be completed and incorporated in
Electrical permits as appropriate as an accountable document for all High Voltage
Switching and permitted work and used as an aid memoir during the switching
process.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person undertaking/in charge of the work.
2nd Copy (Yellow) – To Estates Services Electrician via Estates Helpdesk.
3rd Copy (Pink) – Development or Maintenance as appropriate.
4th Copy (Bottom copy) – Retained in permit book as an accountable document.
Permit to Work – Pressure Systems4 (Appendix 6).
Quadruplicate Book
Duty holder: Maintenance Engineer, Mechanical Services Engineer,
Mechanical Services Supervisor and Mechanical Services Assistant
Supervisor plus any competent person authorised in writing by the Director
of Estates Services or the Mechanical Services Engineer.
4
Please route a copy via Helpdesk and inform them when the permit is cancelled.
All work on the compressed air and pressure systems that fall under the ‘Pressure
Systems Regulations’ and for which Estates Services are the duty holder shall be
undertaken under this permit.
A. The Person Issuing this permit is to:
(1) Complete and sign Part 1 of the Permit and the copy contained in
the Book and hand the Permit to the person permitted-to-work.
(2) Destroy the Permit when the section contained in the Book covering
Return of Permit has been complete and signed.
(3) Sign the section contained in the Book covering Cancellation of
Permit to confirm that action as at A (2) has been taken.
B. The Person permitted-to-work is to:
(1) Acknowledge holding the Permit by signing Part 2 of the Permit and
of the copy contained in the Book.
(2) Retain the Permit while the work is proceeding.
(3) Retain the Permit when the work is completed/suspended, and
(4) Complete and sign the section contained in the Book covering
Return of Permit.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person undertaking/in charge of the work.
2nd Copy (Yellow) – To Estates Services Electrician via Estates Helpdesk.
3rd Copy (Pink) – Development or Maintenance as appropriate.
4th Copy (Bottom copy) – Retained in permit book as an accountable document.
Confined Spaces and Controlled Areas access request forms5.
Confined Spaces (Appendix 11)
Triplicate Book
Duty Holder… See explanation following.
The permit to enter a Confined Space (Appendix 11) must be issued for all work
undertaken in such spaces. The person issuing the permit should be fully
competent to manage such work and conversant with their legislative
5
Ditto
responsibilities. Attendance on a One day ‘Confined Spaces training with Escape
Apparatus’ course (or approved equivalent) allied to a thorough knowledge of the
space, site conditions and hazards contained therein would exemplify such
competence.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person.
1st Copy (Yellow) – Helpdesk.
Bottom Copy (Light Blue) – To be retained in permit book.
Access Request Form - Controlled Areas6. (Appendix 7)
Triplicate Book
Duty Holders…Maintenance Engineer, Mechanical Services Maintenance
Engineer, Electrical Engineer, Technical Assistant, Building Services
Technician, Maintenance Officer, Assistant Maintenance Officer, University
Surveyor, Building Technicians, Building Surveyor, Assistant Building
Surveyor, Small Works Manager, Development Engineer, Electrical Engineer,
Mechanical Services Engineer and anyone authorised in writing by the
Director of Estates Services.
This authority to enter a Controlled Area (Appendix 7) (NB. Not a Confined Space)
should be utilised for access control of all technical areas where specific hazards
exist over and above routine access into areas designed for such. Such areas will
be incorporated into the Safe System of Work to which these permits relate and
include West Park Voids, Edward Herbert Building plantroom void, Holywell Park
underground walkways and the like.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person.
1st Copy (Yellow) – Helpdesk.
Bottom Copy (Light Blue) – To be retained in permit book.
6
Ditto
Access Request Forms - Roofs (Appendix 8).
Triplicate Book.
Duty holders; Maintenance Engineer, Mechanical Services Maintenance
Engineer, Electrical Maintenance Engineer, Technical Assistant, Building
Services Technician, Maintenance Officer, Assistant Maintenance Officer,
University Surveyor, Building Technician, Assistant Building Surveyor, Small
Works Manager, Development Engineer, Electrical Engineer, Mechanical
Services Engineer and anyone authorised in writing by the Director of
Estates Services.
The Roof Access request Form (Appendix 8) is an integral part of The University
Code of Practice for Access to Roofs. Where access is required through voids and
loft areas onto roofs, once the roof access request form has been completed by
the person requiring access (or a University Officer on their behalf in the case of
contractors working for departments), an Authority to be on site and working (Form
of Authority): (Appendix 1) should be completed by the duty holder and issued to
enable the issue of keys. The Key Clerk will issue keys only when this form has
been completed and has no authority to waiver or adapt this requirement. The duty
holder retains the responsibility to ensure that those being allowed access have
conformed to the policy and for forwarding the completed Roof Access request
Form to the Estates Helpdesk.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person.
1st Copy (Yellow) – Helpdesk.
Bottom Copy (Light Blue) – To be retained in permit book.
Excavations - Permit to Dig (Appendix 9).
Triplicate Book.
Duty holders: Maintenance Engineer, Mechanical Services Engineer,
Maintenance Officer, Assistant Maintenance Officer, Development Engineer,
University Surveyor, Assistant Building Surveyor or their nominated
deputies plus anyone authorised in writing by the Director of Estates
Services.
The Permit to Dig (Appendix 9) shall be utilised to cover work at all University
locations. A current record drawing of the area, which should indicated the area of
work geographically, must accompany the permit.
The Project Manager/ S.O. or designated authority and the person producing the
permit are required to attend the proposed work site and risk assess the area prior
to the permit to be prepared.
The visit might be combined where detailed permits are required covering
extensive areas. Other than in emergency situations, the permit request must be
made at least two working days in advance.
The Project Manager/ S.O. or designated authority shall ensure that a specific risk
assessment and/or method statement covering the work for which the permit is
required have been prepared by the contractor before the permit is issued.
The permit makes reference to a requirement to accord with the requirements of
HSG 477 or an approval equivalent standard.
Where a contractor is recognised as not having the competence to fulfill the
requirements of HSG 47, the person issuing the permit will undertake the role.
NB. This would not be the case for contractors carrying out excavations but is
included to cover contractors such as those erecting marquees, driving pickets and
the like.
Copies to be distributed as follows:
Top Copy (White) – Contractor or Trades Person.
1st Copy (Yellow) – Helpdesk then onto the Grounds and Gardens Section.
Bottom Copy (Light Blue) – To be retained in permit book.
7
HSG 47, Avoiding Danger from Underground Services, 2000,
HSE Books ISBN 0 7176 1744 0
Hot Work (Appendix 10).
Duplicate.
Duty holders: Maintenance Engineer, Mechanical Services Maintenance
Engineer, Electrical Maintenance Engineer, Technical Assistant, Mechanical
Services Supervisor, Assistant Mechanical Services Supervisor, Building
Services Technician, Maintenance Officer, University Surveyor, Assistant
Maintenance Officer, Building Technician, Assistant Building Surveyor,
Small Works Manager, Development Engineer, Electrical Engineer,
Mechanical Services Engineer, Furniture and Design (FAD) Manager, FAD
Coordinator and FAD Assistant Coordinator and anyone authorised in
writing by the Director of Estates Services.
The Hot Work Permit (Appendix 10) shall be utilised for all hot work carried out by
both contractors and the direct labour force.
The operative must return the original to the person issuing the permit for
cancellation once all hot work has ceased.
Author:
Norman Elkington IEng MSc CMIOSH MSOE MIPlantE
Chartered Safety and Health Practitioner
Departmental Health, Safety and Sustainability Coordinator
Estates Services
Loughborough University
1 December 2005
Appendix 1
Key and Work Authority Estates Controlled Areas
NB. EVERY ITEM MUST BE FILLED IN OR DELETED AS APPROPRIATE
1. ACTIVITY
Location :
NOTE: No service isolations or work on services are allowed without appropriate authority.
Brief description of Work:
2. PRECAUTIONS TO BE OBSERVED – Aide Memoir
YES
NO
No naked lights, lighters or matches to be taken into the area
Access equipment to be used
Specify ……………………………………………..
Lone working monitoring system to be used
Specify ……………………………………………..
Safety harness to be worn
Safety barriers to be erected
Warning notices to be posted
Key authority issued
Personal protective equipment to be used (delete as necessary):
EYE
EAR
MASK
HELMET
OTHER
(specify below)
Other PPE …………………………………………………………………………………………………………………………………………..
Other precautions or special conditions or additional permits issued:
………………………………………………………………………………………………………………………………………………………
3. AUTHORISATION FOR KEY ISSUE – FORM NOT VALID UNTIL AUTHORISED
Please Issue keys to (name of company or individual)…………………………………………………
For the following location (s)
Building………………………….Room:………………Roof Access………………..Void Access…………..
Authority valid from …………..hrs on ………….
To……………hrs on……………
Authorised by (print) : …………………………………… SIGNATURE: ……………………………………………
Note: Keys to be returned to the key office on a daily basis.
Please be advised that if keys are lost, you must inform the key clerk immediately. You may be charged for
their replacement and any associated consequential losses.
Keys Received by (print) : ………………………
Signature: …………………………..
Appendix 2
Fire Alarm Isolation Request
To: The Electricians/Electrical Team
Person requesting the isolation: ……………………………………………..
Works requisition Numberif applicable) ………………………………….
Division/Department/Section:…………………………………………………
Description of work to be carried out:
Location:
Date to be isolated:
Time:
/
/
Date to re-instate:
/
Time:
hours
/
hours
Isolation Information
Outstation Numbers:
Loop Number:
Panel Number:
Isolated by:
Date:
/
/
Time:
hours
A copy of the completed form must be forwarded to the Health and Safety Office for onward
transmission to the University’s Insurers where a significant portion of a system is isolated for
more than one working day.
Appendix 3
ELECTRICAL LOW VOLTAGE PERMIT-TO-WORK
Parts 1,3 and 4 to be completed for all electrical work undertaken by contractors.
Parts1, 2,3,4 and 5 to be completed for all work where isolation is undertaken by the Estates
Services duty holder on behalf of the competent person.
Part 1
Authorisation to Work
The permit is issued by (print name)
(Estates Services Duty Holder)
For the following work:
Issued to (print name)
for doing the work.
Switching and Isolating.
being a Competent Person responsible
Part 2.
Declaration (If a written permit is issued to a third party for the work).
I hereby declare that the operations detailed in the notes in the cover sheet have been
complied with and the apparatus detailed in part 1 is safe to work on and any adjacent live equipment is
protected against accidental or unauthorised contact.
It will not be made ‘Live’ until the Clearance of Work Part 4 is completed. All Other Apparatus is to be
considered as Dangerous.
Signature of Authorised Person:
Print Name:
Time:
Date:
Part 3.
Receipt (By contractor or trades staff undertaking work).
I hereby declare that I accept responsibility for doing the work on the apparatus detailed in Part 1 of this
permit and that no attempt will be made by me or by person(s) under my control to work on any other
apparatus.
Signature of Person:
Print Name:
Time:
Date:
Part 4.
Clearance of Work (By Contractor or trades staff undertaking work).
This is to certify that the work detailed in Para 1 above has been stopped/completed* ,
persons, gear and tools withdrawn, local earths removed, testing completed and the system is safe to
make live/has been made live. (delete as appropriate).
Signature of Person:
Print Name:
Time:
Date:
Part 5.
Cancellation (If written permit was issued by Estates Services duty holder).
I hereby declare the earth connections originally applied have been removed, the system has been tested
and is safe to make live and this Permit-to-Work is hereby cancelled.
Signature of Person:
Print Name:
Time:
Date:
LOW VOLTAGE PERMIT-TO-WORK
To be inscribed on both the inside and outside faces of the Permit cover sheet.
NOTES
THIS PERMIT SHALL BE UTILISED FOR ALL LOW VOLTAGE ELECTRICAL WORK
Part 1 Should be completed by the Estates Services Duty Holder responsible for
the work. Where the person authorising the work is also responsible for the
switching etc, they may issue this permit to themselves as a check on procedures.
The apparatus is to be disconnected from all live conductors before work
commences.
Part 2 Should be completed by the Estates Services Duty Holder who is
responsible for switching, isolating, testing and earthing operations prior to issuing
the permit and work commencement.
Part 3 Should be signed by the Competent person actually in charge of the work
on the apparatus. The original should be retained by the Competent Person
actually in charge of the work until the work is stopped or completed. One copy
should be retained in the book by the person authorising the work.
Part 4 Should be signed by the Competent Person actually in charge of the work
when the work has been stopped or completed and then handed back to the
person who authorised the work.
Part 5 Should be signed by the Estates Services Duty Holder responsible for
signing Part 2, or in his unavoidable absence, by a person of equivalent electrical
status and who has knowledge of the work.
* delete the word that does not apply.
Appendix 4
ELECTRICAL HIGH VOLTAGE PERMIT-TO-WORK
SERIAL NUMBER……………..
Part 1
Authorisation to Work
The permit is issued by (print name)
For the following work:
To (print name)
being a Competent Person responsible for doing the work.
Switching and Isolating. Switching schedule number
The apparatus is to be disconnected from all live conductors by the following operations:
………….
Potential Tests and Earthing. Potential Indicator test to be applied at the following points.
Danger Notices are to be posted at: .
Caution Notices are to be posted at: .
Part 2.
Declaration
I hereby declare that the operations detailed in Part 1 have been completed and the apparatus detailed in part 1 is safe to
work on, and any adjacent live equipment is rendered safe.
It will not be made ‘Live’ until the Clearance of Work Part 4 is completed. All Other Apparatus is to be considered as
Dangerous.
Signature of Authorised Person:
Print Name:
Time:
Date:
Part 3.
Receipt
I hereby declare that I accept responsibility for doing the work on the apparatus detailed in Part 1 of this permit and that no
attempt will be made by me or by person(s) under my control to work on any other apparatus.
Signature of Person:
Print Name:
Time:
Date:
Part 4.
Clearance of Work
This is to certify that the work detailed in Para 1 above has been stopped/completed* persons, gear and tools withdrawn,
local earths removed, testing completed and the installation is safe to make live.
Signature of Person:
Print Name:
Time:
Date:
Part 5.
Cancellation
I hereby declare this Permit-to-Work cancelled, and the earth connections applied at points indicated in Part 1,c, have been
removed.
Signature of Person:
Print Name:
Time:
Date:
HIGH VOLTAGE PERMIT-TO-WORK
To be inscribed on both the inside and outside faces of the Permit cover sheet.
NOTES
Part 1 Should be completed by the Authorised Person responsible for the
switching, isolation, testing and earthing operations and issued to the person
responsible for carrying out the work. Where the person authorising the work is
also responsible for the switching etc, they should issue this permit to themselves
as a check on procedures.
Part 2 Should be completed by the Authorised Person responsible for switching,
isolating, testing and earthing operations after their completion.
Part 3 Should be signed by the Competent person actually in charge of the work
on the apparatus. The original should be retained by the Competent Person
actually in charge of the work until the work is stopped or completed. The
duplicate should be retained by the person authorising the work. See also below.
Part 4 Should be signed by the Competent Person actually in charge of the work
when the work has been stopped or completed and then handed back to the
person who authorised the work.
Part 5 Should be signed by the Authorised Person responsible for signing Part 2,
or in his unavoidable absence, by a person of equivalent electrical authority who
has thorough knowledge of the work.
* delete the word that does not apply.
Copies to be distributed as follows.
Original. Person carrying out the work.
1st copy. To Development/Maintenance for information.
2nd Copy. To Estates Services Electricians/Estates Helpdesk.
4th Copy. Retained in permit book as an accountable document.
Appendix 5
SWITCHING SCHEDULE
Switching Schedule Number : ………………………………
From:
hrs On:
200
To:
hrs On:
200……
THE FOLLOWING EQUIPMENT IS AFFECTED:
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
WORK TO BE CARRIED OUT:
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
SWITCHING PROCEDURE OVER PAGE
Program prepared by:
Checked By:
Print Name:
Print Name:
Authorised person in Charge of Work:
Approved by Site Manager
Print Name:
Note:- Possession of an approved Schedule does not give the authority to commence operations. This schedule
must be enabled by a permit to work issued by the Authorised person.
Appendix 5 reverse sheet.
SWITCHING SCHEDULE FOR DECOMMISSIONING THE SYSTEM
HV Transformer MB3
No.
LOCATION
OPERATION
???
???
Date
Signature
1
2
3
4
5
6
7
8
9
10
CARRY OUT WORK ON PERMIT NUMBER ………………. CHANGE MIMIC DIAGRAM
SWITCHING SCHEDULE FOR REINSTATING THE SYSEM
1
CANCEL PERMIT NUMBER ..
2
3
4
5
6
7
8
Energy centre (mimic
panel if appropriate)
9
10
CHANGE MIMIC
DIAGRAM/MASTER
DRAWING
Replace key ….lock mimic
panel
Appendix 6
PERMIT TO WORK PRESSURE SYSTEMS
BOILERS, PRESSURE VESSELS, PRESSURE SYSTEMS
PART 1
I hereby declare it is safe to work on the following equipment, which has been isolated and
prepared in accordance with the Pressure Regulations 2000 and LU Estates Services Safety
Regulations and Procedures, Pressure Systems.
The person permitted to work is aware of the relevant safety Regulations in this section.
Establishment………………………………………………………………………..…………………
Building/Installation……………………………………………………………………………………
…………………………………………………………………………………………………………….
Equipment Identification No…………………………………………
State here the action, which has been taken to isolate and prepare the equipment:
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………
Danger and Caution Notices have been posted at:
……………………………………………………………………………………………………………………
…………………………………………………………………………………………………..
Signed…………………………… Officer-in-charge of the Plant
Date…………………………
Time……………….hrs
PART II
I acknowledge holding this Permit and declare that I am in Charge of the work set out thereon being
competent in all aspects. I am aware of the safety arrangements and declare that no attempt will
be made by me or by men under my control to work on any other equipment.
Signed ……………………………………………………………Time……………………..hrs
In the employ of……………………………………………………Date ………………………..
Part III
RETURN OF PERMIT
I hereby declare that the work detailed in Part I of the Permit has been completed and that all men
under my charge have been warned that it is no longer safe to work on the equipment on the
Permit.
Signed ………………………………………….…………
Time ………………….hrs
In the employ of …………………………………………
Date ……………………...
CANCELLATION OF PERMIT
I hereby declare that the Permit is cancelled and has been destroyed by me.
Signed ………………………
Officer-in-Charge Time ………………hrs Date ……………
PERMIT TO WORK PRESSURE SYSTEMS
To be inscribed on the inside face of the Permit cover sheet.
NOTES:
A The Person Issuing this permit is to:
(1)
Fill in and sign Part I of the Permit and the copy contained in the Book
and hand the Permit to the person permitted-to-work.
(2)
Destroy the Permit when the section contained in the Book covering
Return of Permit has been filled in and signed.
(3)
Sign the section contained in the Book covering Cancellation of Permit
to confirm that action as at A (2) has been taken.
B The person permitted-to-work is to:
(1)
Acknowledge holding the Permit by signing Part II of the Permit and of
the copy contained in the book.
(2)
Retain the Permit while the work is proceeding.
(3)
Return the Permit when the work is completed/suspended, and
Fill in and sign the section contained in the Book covering Return of Permit.
Appendix 7
Access Request Form – Controlled Areas
Exact Location (s) of Voids to be entered(Name of Building and Area)
Purpose for which Entry is Required:
Dates for which access is required:
Personnel/Company Authorised to Enter.
Hazards possible within the space:
See LUES Annex F Appdx 1(Rev 1)
Name of person Authorising access:
Position:
Communications method and equipment to be used by the attendant (top man) and authorised entrants:
Radio Communication immediately before each access and immediately on exiting void.
Telephone communication is an acceptable alternative where radio communication is not possible but this alternative
arrangement must be authorised before use.
Equipment Required for compliance with this authority:
Personal Protective Equipment: Full overalls, hard hat, gloves as necessary. See also Individual RA for work to be undertaken.
Testing Equipment: See individual Risk Assessment
Communications Equipment:
Alarm Systems: Use of Radio (or mobile telephone if authorised).
Other Equipment: See Risk Assessment
Any additional Permits required covering the space or services affecting the space to be accessed:
I hereby declare that I have read and will comply with Estates Services policy ENTERING AND WORKING IN CONTROLLED
AREAS and have undertaken a suitable and sufficient Risk Assessment for the intended work. All persons under my
charge have been suitably trained and made aware of the risks associated with entry into the voids.
Signed: -
Print: -
Date: -
(Person In charge of the work)
I certify that I have viewed the Risk Assessment that it is specific to the work at hand, and that keys may be
issued to access the area(s) identified above.
Signed: Print: (Person authorising access to the voids)
Date: -
Appendix 8
Access Request Form – Roofs
(Use Controlled Areas access request where access to roof is through void)
Exact Location (s) of Roof (s) to be accessed:
Purpose for which Access is Required:
Dates for which access is required:
Personnel/Company Authorised to Access.
Name of person Authorising access:
Position:
Equipment Required for compliance with this authority(e.g. Safety Harness)
Any other Permits/advice issued or required covering the roof or services affecting the roof
to be accessed: (e.g. Radiological, Electrical, Pressure Systems, Hot Work COSHH
Assessment, void access)
I hereby declare that I have read and will comply with Estates Services policy WORK ON
ROOFS and have undertaken a suitable and sufficient Risk Assessment for the intended
work. All persons under my charge have been suitably trained and made aware of the risks
associated with working on roofs.
Signed: (Person In charge of the work)
Print: -
Date: -
I certify that I have viewed the Risk Assessment that it is specific to the work at hand,
and that keys may be issued to access the roof(s) identified above.
Signed: -
Print: -
(Person authorising access to the voids)
Date: -
Appendix 9
PERMIT TO DIG No………
ENGINEERING “PERMIT TO DIG”
To be used in circumstances involving excavation, earth removal deeper than 150mm, digging of
holes, driving of stakes, etc., on all University premises.
To be issued by the Project Manager/Supervisor in charge of the work.
This permit must not be issued unless a site visit has been undertaken by the person issuing and
must be accompanied by an appropriate site plan indicating services.
At least two working days notice must be given unless in emergency situations.
Part 1 (to be filled in by applicant)
Name of applicant:
Description of Work:
Accompanying sketch No:
Date work to commence:
Approx duration of work:
Part 2 (to be completed by authorised Engineering Department Personnel and signed by the
Estates Services Project Manager/Supervisor in charge of the work.)
i
Drawings have been searched and the following indicated:
HV Cables
LV Cables
Street Lighting Cables
BT Cables
Gas Mains
Water Mains
Heating Mains
ARE/ARE NOT PRESENT
ARE/ARE NOT PRESENT
ARE/ARE NOT PRESENT
ARE/ARE NOT PRESENT
ARE/ARE NOT PRESENT
ARE/ARE NOT PRESENT
ARE/ARE NOT PRESENT
Other hazards indicated: ……………………………………………….
ii
A site search for the following HAS/HAS NOT been carried out with tracing
equipment.
`
HV Cables
ARE/ARE NOT PRESENT
LV Cables
ARE/ARE NOT PRESENT
Street Lighting Cables
ARE/ARE NOT PRESENT
BT Cables
ARE/ARE NOT PRESENT
Other. ……………………………………………………………………………
iii The following precautions have been taken:
Power lines HAVE/HAVE NOT been rendered safe.
Power lines/cables/pipes, etc., HAVE/HAVE NOT been approximately located, and indicated to the
applicant
Comments:
This permit is valid for
(normally 4 weeks Maximum).
I certify that to the best of my knowledge and belief all services contained in the area described
above have been indicated to the applicant in charge of the work. Other unknown services may
however be present and all reasonable precautions should be taken to avoid accidental damage or
injury. If the working area is to be extended an additional permit or permits must be obtained. Note
that barriers must be erected around excavation at all times.
Signed: (Estates person in charge of work)……………………………..…..Date:……………
Received; (Person undertaking the dig). Signed:
Date: ………….
One copy of this permit should be forwarded to the Estates Services Grounds and Gardens.
Appendix 10
HOT WORK PERMIT
Applies Only To Area Specified Below
Section I and II to be completed by LU Estates
Section III to be completed by Contractor
SECTION I to be completed by LU Estates
Building
Floor/Roof
(Delete as appropriate)
Nature of Job (including exact location)
Contractor
Date of Issue
Date of Expiry
Signature of Person Issuing Permit
Print Name
SECTION II to be completed by LU Estates prior to handover to Contractor
Precautions
(The person carrying out the work is to take note of all of the following, in particular those
that have been ticked together with any locally appropriate items as listed)
Is cutting and welding equipment in good repair and adequately secured?
Have local fire detectors/alarms been neutralised/isolated?
Note: See fire alarm isolation request
Precautions within 15m of work
Are floors swept clean of combustible materials?
Are combustible floors protected by wetting down and covering with damp sand or sheets
of non-combustible material?
Are combustible materials and flammable liquids protected with non-combustible curtains
or sheets or can they be moved to a safer position?
Are all wall and floor openings covered with sheets of non-combustible material. All gaps in
walls and floor through which sparks could pass covered with sheets of non-combustible
material?
Where works are above floor level, are non-combustible curtains or sheets suspended
beneath the work to collect sparks?
Works on Walls or Ceilings
Are combustible constructions protected by non-combustible curtains or sheets?
Are combustibles moved away from opposite side and clear of any metal likely to conduct
heat? (Where beams are being worked on, and extend through walls or partitions,
precautions must be taken on the far side of such a wall.)
Are Bitumen boilers sited in the agreed position in a metal catchment tray? Are the LPG
cylinders at least 3 metres from the boiler?
Fire Watch
Make provision for the attendance of an employee during and for one hour after completion
of work. Such employee being supplied with extinguishers or small bore hose and trained
in the use of such equipment and in sounding an alarm.
Is the fire extinguisher type available appropriate to the work?
Signature of person carrying out the above check
Print Name
SECTION III to be completed by Contractor
Date
Time
Started
Time
Finished
Final Check
Signature
Print Name
I hereby declare that all work covered by this permit is complete and that a site inspection
was undertaken at least one hour after all hot work ended.
All fire detectors have been restored to their operational state.
Signed: …………………………………………Time: ……………………… Date: ………
After completing the works and signing return the permit to person who issued it.
Appendix 11
Permit To Enter A Confined Space
Identification of Space to be entered:
Purpose for which Entry is Required:
Date of Start of Permit:
Date of End of Permit:
Personnel Authorised to Enter.
(No other personnel are allowed entry into the space without formal permission from
the signatory of this permit).
NB. This permit must not be extended. If an
extension of time is required, this Permit must be
cancelled and a new one issued.
Name of person Supervising Area prior to issue of this permit:
Position:
Hazards possible within the space:
Measures taken to isolate the space and/or control the hazards prior to entry:
Acceptable entry conditions:
Atmospheric:
Energy Control measures: (Points of isolation of services etc.).
Measures employed to attain and ensure continuation of acceptable conditions:
Record of periodic monitoring/testing results.
Name of person carrying out test.
Time and date.
Result(s).
Rescue and Emergency Services to be contacted in Emergency:
Mode of contacting Rescue services:
Communications method and equipment to be used by the attendant (top man) and authorised entrants:
Equipment Required for compliance with this permit:
Personal Protective Equipment:
Testing Equipment:
Communications Equipment:
Alarm Systems:
Rescue Equipment:
Other Equipment:
Other Permits existing covering the space or services
affecting the space.
Signed:
Position:
Print Name:
Date of Issue:
To be completed by Estates Manager/Equivalent
Withdrawal from Confined Space.
I hereby declare that all persons under my charge have left the confined space and that the space has been
secured against unauthorised re-entry.
Signed: Date: (Person In charge of the work)