CONCRETE CUTTING, CORING, CHASING & DRILLING PERMIT
Note: This permit is to be completed for all penetrations exceeding 40mm in depth
Reference
Trade:
Company name
Type / size
e.g. coring / 100mm
Location of concrete cutting, coring or drilling works:
Attach marked up drawing or sketch showing location of works
Clearly set out works
Attached
Not attached
Are core holes, chases & cutting lines clearly marked outlining location, position & depth?
On surface
Yes
No
N/A
Structural Considerations
Attach engineer approval of the proposed works
Engineer's report or advice to be attached
Attached
Not attached
Notes
Has the engineer requested a scan
If yes, please attach
Yes
No
Notes
Have structural components within the slab or wall been located and marked?
(i.e. prestressed cables & reinforcing steel)
Yes
No
N/A
Notes
Services Considerations
Have all identified services been located and marked?
Note: A copy of the site service plan (mud map) is to be attached to the permit.
Electrical
Yes
No
N/A
Notes
Mechanical Electrical
Yes
No
N/A
Notes
Dry Fire
Yes
No
N/A
Notes
Water
Yes
No
N/A
Notes
Gas
Yes
No
N/A
Notes
Future conduits
Yes
No
N/A
Notes
Other
List other services
Yes
No
N/A
Notes
Insitu concrete elements only: is scan required?
Scan required if services are present regardless of distance – Copy of scan to be attached
Yes
No
N/A
Notes
Services Trades Sign Off [insitu concrete elements only]
Service trades (i.e. electrician, plumber, etc) are required to complete the section below as acknowledgement they have reviewed the permit conditions and locations and that there are no services or services have been isolated within the work area. (Note: If subcontractor is not available, an email confirmation may be attached)
Electrical Subcontractor
Name
If subcontractor is not available, an email confirmation may be attached
Sign
Plumbing
Name
If subcontractor is not available, an email confirmation may be attached
Sign
Other
Trade
Name
If subcontractor is not available, an email confirmation may be attached
Sign
Other
Trade
Name
If subcontractor is not available, an email confirmation may be attached
Sign
HSE Considerations
Are concrete cutting, coring, chasing or drilling works covered in a safe work method statement (SWMS) that has been reviewed and accepted using the SWMS Checklist?
Yes
No
Notes
SWMS name
Notes
SWMS reference number
Notes
Has the worker signed up to the SWMS
Yes
No
Notes
Has the environmental aspects of slurry water from concrete cutting / coring been assessed following the hierarchy of control?
Yes
No
N/A
Notes
Have hazards and control measures associated with silica dust been assessed following the hierarchy of control?
Yes
No
Notes
Are noise control measures in place following the hierarchy of control?
Yes
No
N/A
Notes
Are semi-enclosed / enclosed areas ventilated to prevent build-up of carbon monoxide or other fumes (e.g. extraction system or fans)?
Yes
No
N/A
Notes
Are barricades in place adjacent works?
Yes
No
N/A
Notes
Has the area beneath the slab or wall been isolated / barricade, with signage displayed and a spotter in place?
Yes
No
N/A
Notes
Traffic management addressed (onsite & offsite / public)
Yes
No
N/A
Notes
Works must not commence if ‘No’ has been identified in any of the above sections works until all 'No' items have been rectified.
Permit Reviewer
Reviewer Name
Position
Add notes if other
Site Manager
Project Manager
Construction Manager
Notes
Reviewer Signature
Sign