KN Network Services - Job Diary Information Sheet

Job Information
KN Reference : 1187081 Received Date 05/04/2017 12:08:45
Client Reference : IBQ9PGTK RBD : 07/07/2017 00:00:00
NIMs Reference : 17600719 LRBD : 07/07/2017 00:00:00
VLAD :
Planner : STUART DENNISON
Job Category : H7 (BDUK Plan & Build)
Telephone : 02086662673
Date Fit for Purpose :
Main Program # : F569
f FFP date shown this is the date you need to complete your
Sub Program # : 9230 works by, as follow up activities are required also

Important Fluidity Information

GridRef 366309796776 Work Stream
Exchange BVH ( BANCHORY )
Address : OPP WAYSIDE COTTAGE NORTH DEESIDE ROAD A93 INCHMARLO BANCHORY AB31
4FN
Notes :

Project CU rearr/build E/O

Desc :
Road Type: Waived
Notice Period :
Job Duration :
Earliest Start Date :
Latest Start Date :

Products to be Completed
Work Description: Units
Rate Description Plan DFE Cost Sales
N35E E0 Intervention Non Pressure to Non Pressure 1st 1 4.00 0.00 0.00 0.00
KNUK FRM-HSE-0040
Version : 1.0 Permit to Dig / Drill
Author: Julie Saville
Date: 22/08/08

Permit to Dig / Drill

Project/Station BT CITY FIBRE LA Ref

Expiry
Start Date Date
To be completed by the ‘competent person’
Section 1 Application responsible for the works being undertaken.

Description of the works – circle Classification;

Dslam stand civils PCP stand civils Blockage(s)

Mole Plough Box Building Duct Work

Other: ____________________________________________________________

Estimate Number/Client Reference: _____________________________________

Yes No

Are current issue drawings showing location, type and status (eg live / dead)
Of all known services in the area of the dig/drill available?

Drawing reference number

Has a visual survey of the location of the dig/drill been carried out?

Is there an approved method statement in place, confirming the location of the dig/drill?

What is the method statement number

Is there an approved cable locating device available on site?

Is the cable location device calibrated?

What is the calibration date?

Are all operatives conversant with safe drilling/digging practices?

Is there competent supervision available for the works?

I hereby declare that the above precautions will be put into effect before the works commence.
Name......................................................... Signature................................................................

Date.......................................................... Time.......................................................................

Section 2 Issue Authorisation can only be completed by the

KN ‘Authorised Person.’
Yes No

Has a CAT scan been carried out?

Have all known services been marked up?

Details of trail holes required_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _

____________________________ _________________________

Details of precautions needed to execute the works (eg PPE, fencing, shoring)_ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_____________________________________________________

I am satisfied that the precautions identified above are satisfactory for the works to be undertaken.

Work may proceed Work may not proceed

Additional Action Required.

Name......................................................... Signature................................................................

Date.......................................................... Time.......................................................................

Section 3 Clearance All permits must be cleared by the KN

‘Competent Person.’

I hereby confirm that the work to which this permit related is now complete. All persons and materials are
now clear. The site has been left in a safe condition (physical / visible edge protection, warning notices,
securely fixed marking cover.)

Name......................................................... Signature................................................................

Date.......................................................... Time.......................................................................

Section 4 Cancellation All permits must be cancelled by the KN

‘Competent Person.’

I am satisfied that the work has been left in a safe condition. The permit is hereby cancelled.

Name......................................................... Signature................................................................

Date.......................................................... Time.......................................................................