Annex Z to LUES H&S Policy Estates Services Safe Systems of Work and Permits

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1 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.

2 - 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.

3 - 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 permits 1 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

4 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 1 st 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.

5 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/Test 2. (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.

6 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. 2 nd Copy (Yellow) To Estates Services Electrician via Estates Helpdesk. 3 rd Copy (Pink) Development or Maintenance as appropriate. 4 th Copy (Bottom copy) Retained in permit book as an accountable document. Electrical High Voltage Permit to Work/Test 3. (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

7 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. 2 nd Copy (Yellow) To Estates Services Electrician via Estates Helpdesk. 3 rd Copy (Pink) Development or Maintenance as appropriate. 4 th Copy (Bottom copy) Retained in permit book as an accountable document. Permit to Work Pressure Systems 4 (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.

8 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. 2 nd Copy (Yellow) To Estates Services Electrician via Estates Helpdesk. 3 rd Copy (Pink) Development or Maintenance as appropriate. 4 th Copy (Bottom copy) Retained in permit book as an accountable document. Confined Spaces and Controlled Areas access request forms 5. 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

9 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 Areas 6. (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

10 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

11 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 47 7 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

12 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

13 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 Lone working monitoring system to be used Safety harness to be worn Safety barriers to be erected Warning notices to be posted Key authority issued Specify.. Specify.. 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:..

14 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: / / Date to re-instate: / / Time: Isolation Information hours Time: hours 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.

15 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) being a Competent Person responsible for doing the work. Switching and Isolating. 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:

16 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.

17 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:

18 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. 1 st copy. To Development/Maintenance for information. 2 nd Copy. To Estates Services Electricians/Estates Helpdesk. 4 th Copy. Retained in permit book as an accountable document.

19 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.

20 Appendix 5 reverse sheet. SWITCHING SCHEDULE FOR DECOMMISSIONING THE SYSTEM HV Transformer MB3 No. LOCATION OPERATION?????? Date Signature CARRY OUT WORK ON PERMIT NUMBER. CHANGE MIMIC DIAGRAM SWITCHING SCHEDULE FOR REINSTATING THE SYSEM CANCEL PERMIT NUMBER.. 8 Energy centre (mimic panel if appropriate) 9 10 Replace key.lock mimic panel CHANGE MIMIC DIAGRAM/MASTER DRAWING

21 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. In the employ of Time.hrs 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

22 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.

23 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: - Date: - (Person authorising access to the voids)

24 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: - 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 roof(s) identified above. Signed: - Print: - Date: - (Person authorising access to the voids)

25 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 ARE/ARE NOT PRESENT LV Cables ARE/ARE NOT PRESENT Street Lighting Cables ARE/ARE NOT PRESENT BT Cables ARE/ARE NOT PRESENT Gas Mains ARE/ARE NOT PRESENT Water Mains ARE/ARE NOT PRESENT Heating Mains 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.

26 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 Nature of Job (including exact location) Floor/Roof (Delete as appropriate) 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?

27 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.

28 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: NB. This permit must not be extended. If an extension of time is required, this Permit must be cancelled and a new one issued. Personnel Authorised to Enter. (No other personnel are allowed entry into the space without formal permission from the signatory of this permit). 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)