Document No.

: S-W-001
Revision : 3
FUGRO GEOTECHNICAL SERVICES LIMITED Date Issued : 29 Sep 2012
Page 1 of 4

Work Instruction for Application of Permit to Work System for Ground

Investigation works

1.0 Introduction

FGS recognizes that appropriate control over the potential safety and/or environmental
impacts of activities to be undertaken by FGS, is essential for the protection of the
environment, the health and safety of FGS's employees and the public. A Permit to
Work system is in place for the construction work activities performed involving, but not
limited to, ground investigation drilling, vibocoring, cone penetration test(CPT), trial
pit/trench excavation, or any other ground penetration works.

2.0 Purpose

The Permit to Work system is a formalised process to control work and access to
identified areas designed to prevent incidents in the workplace. The written system is
used to control certain types of work or work areas that are potentially hazardous and
contains a permit to work document which specifies the work to be done and the
precautions to be taken. This process authorises work only after safe procedures have
been defined and they provide a clear record that all foreseeable hazards have been
considered.

3.0 Scope

This work instruction outlines the permit-to-work system, aimed at reducing the risk of
incidents related to potentially hazardous activities or work areas. This work instruction is
applicable to all staff and contractors working at all site areas.

4.0 Definitions

4.1 UU (Underground Utilities) means all utilities or substructures beneath the surface of
the ground level which include: electricity cables; gas, water pipes and sewage;
telephone lines; fiber optics, etc.

4.2 Desk Study Report means a report to address all the underground utilities in the
vicinity of the site area. It should be approved by the Site Agent, Project Engineer or
Project Manager before issuing.

4.3 CP (Competent Person) means a person approved as a competent person under

section 3 of the Electricity Supply Lines Protection Regulation (ESLPR).

4.4 AP (Appointed Person) means a person appointed by the Project Manager or Site
Agent to carry out the desk study and the person has already attended a course in the
locating of underground electricity cables.

4.5 Utility Drawings should NOT be considered if the drawings in our hand were provided
more than three months ago for gas and electric or 6 months ago for all other utilities.

A Member of the Fugro Group

 Document No. : S-W-001
Revision : 3
FUGRO GEOTECHNICAL SERVICES LIMITED Date Issued : 29 Sep 2012
Page 2 of 4

5.0 Responsibilities

5.1 Project Manager (PM)

The PM is responsible for ensuring the permit-to-work system is fully implemented

according to this work instruction.

5.2 Site Agent (SA)

The SA is responsible for determining the GI station with the Engineer / Client. The SA
is responsible for collecting information and drawings from the UU companies and
assigns an AP to produce a desk study report. The SA shall review and approve the
desk study report before issuing to the GFT.

5.3 Geotechnical Field Technician / Technician Engineer (GFT)

The GFT is responsible for issuing the permit-to-work to the relevant staff. Before
issuing the permit, the GFT has to confirm no underground utilities are within the
working area and all criteria stated in the permit-to-work check form are fully complied
with. The GFT is fully authorized to stop work if the circumstances or conditions of work
site are not clear or uncertain.

5.4 Safety Officer (SO)

The SO is responsible for monitoring the implementation of the permit-to-work system

by random checking the permit-to-work records regularly.

6.0 Procedures (Onshore Operation)

6.1 During the site meeting, the SA shall determine the proposed GI station with the
Engineer / Client. Working in the vicinity of the utilities should be avoided. Once the
proposed GI station has been agreed, the SA shall arrange to collect utility drawings for
the working areas from all utility companies.

6.2 The SA shall consult or request new drawings from utility company before
commencement of works, if the available drawings in hand have been provided for
more than three months for gas and electric or 6 months for all other utilities.

6.3 The SA shall assign an AP to prepare a desk study report and approve it before
commencement of any works in the vicinity of the utilities.

6.4 The SA shall decide whether the proposed GI station is within the vicinity of utilities in
accordance with the distance stated in the relevant code of practice. If yes, the SA shall
appoint a competent person to carry out utilities detection work and prepare a written
report for the proposed GI station OR discuss with the Engineer/Client to relocate the GI
station beyond the vicinity of the utilities.

6.5 If the proposed GI station is in the vicinity of utilities, hand dig trial holes for the purpose
of confirming and ascertaining the alignment and depth of utilities are required. The CP
should repeatedly use the device and frequently update the working personnel as to the
most accurate utilities location until all target utilities are exposed.

A Member of the Fugro Group

 Document No. : S-W-001
Revision : 3
FUGRO GEOTECHNICAL SERVICES LIMITED Date Issued : 29 Sep 2012
Page 3 of 4

6.6 Once all utilities are identified, the GFT should carefully check the information including
but not limited to desk study report, CP’s written report, utilities drawings and visual
inspection on site to ensure that no utilities will be disturbed or damaged by our
operation.

6.7 The GFT shall arrange digging the inspection pit (at least 2m in depth at rural area / 3m
in depth at urban area) for our GI station and no obstruction has been encountered. If
there is obstruction during digging, the GFT shall stop the work and consult with the SA
to determine if it should be carried on.

6.8 If the inspection pit is successfully terminated at the required depth without obstruction,
the GFT shall carry out the final checking of all plants, equipment, tools and access in
compliance with the regulations then the GFT shall issue the permit-to-work certificate
to the relevant parties to commence of works. If there are any doubts or uncertainties,
the GFT shall refuse to issue the certificate and seek for advice from the SA.

6.9 The SO shall check the permit-to-work system regularly to ensure the implementation of
the permit-to-work System is in place and well maintained.

6.10 After completion of the activity, the GFT shall return the permit-to-work certificate to the
head office for project filing. All issued certificates shall be kept for at least 5 years.

7.0 Procedures (Offshore Operation)

7.1 Once working drawings, indicating investigation station locations, have been issued by
the Client / Engineer, the SA shall arrange to collect utility drawings for the working
areas from all utility companies. The Admiralty Charts shall also be provided.

7.2 The SA shall consult or request new drawings from utility company before
commencement of works, if the available drawings in hand have been provided for
more than three months for gas and electric or 6 months for all other utilities.

7.3 The SA shall act as the AP to prepare a desk study report and approve it before
commencement of any works in the vicinity of the utilities.

7.4 The SA shall determine if any utilities are within the vicinity of the site from the relevant
drawings and charts (see 7.1 above). The SA shall confirm if an exclusion zone has
been specified by the relevant utility owner (and / or shown on the Admiralty Chart).

7.5 If an exclusion zone has been specified, the SA shall determine if any investigation
station locations are within this zone. If any investigation station locations are within the
zone (or sufficiently close that it would mean anchors / jack-up legs encroach into the
exclusion zone) then these investigation station will NOT be carried out until the Client /
Engineer instructs relocation outside of the zone.

7.6 If utilities are present but no exclusion zone has been specified by the utility owners, the
SA should inform the Client / Engineer and seek an instruction with respect to the safe
distance of working away from the utility. At this stage the PM shall take up the
responsibility. Generally a distance of 100m is the minimum acceptable to FGS.
However, any exclusion zone determined by the Client / Engineer is subject to FGS’ PM
/ SO acceptance after assessment of the situation.

A Member of the Fugro Group

 Document No. : S-W-001
Revision : 3
FUGRO GEOTECHNICAL SERVICES LIMITED Date Issued : 29 Sep 2012
Page 4 of 4

7.7 No anchoring within or across an exclusion zone is permitted. No leg penetration from
the jack-up platform is permitted in the exclusion zone.

7.8 The SO shall check the permit-to-work system regularly to ensure the implementation of
the permit-to-work System is in place and well maintained.

7.9 After completion of the activity, the GFT shall return the permit-to-work certificate to the
head office for project filing. All issued certificates shall be kept for at least 5 years.

End of document

A Member of the Fugro Group

Permit To Work Workflow

SA AP GFT CP SO Relevant Parties

Determine proposed
GI station with
Engineer / Client

Arrange to collect
utiltity drawings from
all UU companies and
consult or request
updated drawings*

Prepare a desk study

report

For offshore work

only
Approve the desk
No investigation station study report and pass
locations are within the it to GFT
exclusion zone

Arrange utility Carry out utility detection

detection work for GI work and produce a written
station within our work report
site
Collect the approved
desk study report and
CP's written report, then
mark out the GI station
on site to check whether
it is within the vicinity of
UU

Advise the Engineer /

Client to relocate the GI
Station
Within the
OR
Yes distance?
Instruct to expose# all
utilities within the
distance of vincity
No

Arrange to dig inspection pit

a) at least 3m in depth at
urban area
b) at least 2m in depth at
rural area

Any
Consult with SA
obstruction?
Yes

No

Final check the equipment, Random check the Permit

Allow to tools and access and issue To Work records regularly
work? the Permit To Work
Yes
certificate
No
Receive the completed
Stop work Permit To Work certificate
and start work

Remarks:-
* The information should not be considered if the drawings in our hand have been provided for more than 3 months for cable or 6 months for water and gas.
# Please refer to the COP for details of procedures
 工作許可證 Permit-to-work Certificate
(進行地盤勘探工作 (包括陸地及海上) / 泥井或
泥井或坑挖掘 / 垂直貫穿地面工序 / 斜坡開皮工作專用
斜坡開皮工作專用)
(For Drilling Operation / Trial Pit or Inspection Pit Excavation / Ground Penetration /Slope Stripping)*
第一部分: 工作詳情 Part I: Details of Work
1) 項目名稱 Project Title:____________________________________ 2) 項目編號 Project No: ______________________________

3) 工作指令 Works Order: ___________________________________ 4) 開工日期 Date of Commencement: ___________________

5) 探站編號 GI Station No: __________________________________

6) 工種類別 Nature of Work:
□ 鑽探工作或垂直貫穿地面工序 (陸地) ((項目 8 不適用) □ 鑽探工作或垂直貫穿地面工序 (海上) (項目 3, 4, 5 及 6 不適用)
Drilling or Ground Penetration Operation (Onshore) (Item 8 is Drilling or Ground Penetration Operation (Offshore) (Item 3, 4, 5, &
not applicable) 6 are not applicable)
□ 泥井或坑挖掘 □ 斜坡開皮工作
Trial Pit/Inspection Pit Excavation Slope Stripping
□ 其他 Others __________________________________
第二部分: 施工前準備及控制措施 Part II: Preparation Work and Risk Control Measures (Y: 是 YES, N: 否 NO, NA: 不適用 Not Applicable)
檢查項目 Checking Items Result 結果
1. 已向工程師或客戶確定施工位置。The GI station has been agreed with the Engineer / Client.
2. 已閱讀案頭研究報告，並清楚了解所有在工地內之地下設施位置。
Examined and understood the content of the desk study report completed by the Appointed Person.
3. 已閱讀由合資格人士提交之地下設施位置報告，並清楚了解所有在工地內之地下設施位置。
Examined and understood the content of the underground utilities report completed by the Competent Person.
4. 根據上列項 2 及項 3 之報告及本人清楚，在施工位置 3 米範圍內確認沒有地下設施存在。
According to the desk study report and CP’s written report (if appropriate), there are no underground utilities within 3m
from the GI station.
5. 如項目 4 的答案為「是」請不用回答項目 5, If the answer is “yes” in Q4, please ignore Q5
所有地下設施已被完全掘開及確認與合資格人士提交之地下設施報告之數量一樣並已提供足夠保護。All target
underground utilities were exposed and protected, the quantity should match with the CP’s written report.
6. 已安排挖掘最少 3 米^深的探孔，範圍內並沒有任何阻礙物。
An inspection pit down to the 3m^ depth without obstruction has been formed.
7. 已檢查所有設備、工具 (包括鑽探機、吊重設備、工作台及通道等等)符合安全要求及運作正常 。All equipment, tools and
access have been checked in compliance with the regulations such as drilling rig, lifting gears, platform, access and etc.
8. 根據項 2 之報告及本人清楚，在限制區域內沒有船隻拋錨及在區域範圍內搭建海上工作平台。在限制區域內不會進行海底
垂直貫穿工序。According to the desk study report, there will be no anchoring in or across the exclusion zone, and no
set-up of the jack-up platform in the exclusion zone. No subsea penetration works will be carried out in the exclusion zone.
如上述檢查項目其中一項結果為”否” ，施工許可証則不能簽發，除得到地盤總管及安全主任複查及確認此工程不會對地下或海底設施造成任
何影響，並在此許可証上加簽。If any answer of the above items is “No”, the Permit-to-work Certificate should not be issued unless the Site Agent &
Safety Officer have reviewed and confirmed the work would be carried out without any impact to the underground & subsea utilities and endorse on Part
III.
第三部份 工作許可證之附加簽
工作許可證之附加簽署
:附加簽署 由地盤總管及安全主任填寫
Part III: Endorsement ( to be completed by Site Agent & Safety Officer)
本人已重新審閱相關文件及實地觀察工地情況，確實認知此工程項目沒有對地下或海底設施有任何損毁機會，故同意此工作許可證之申請。
I hereby confirm my re-evaluation of above document and visual inspection on site, no underground & subsea utilities shall be disturbed. I agree

地盤總管
to recommend this application of the permit-to-work certificate.
Site Agent
簽署 Signed by: ________________________/________________________ 日期 Date: ___________________
(全名 Full Name) (簽署 Signature)
安全主任 Safety Officer
簽署 Signed by: ________________________/________________________ 日期 Date: ___________________
(全名 Full Name) (簽署 Signature)
第四部份: 發出/簽收工作許可證
簽收工作許可證 Part IV: Issue/receive Certificate (由註地盤土力技術員填寫 to be completed by GFT)
本人已審閱第二部分(和第三部分, 如適用)所有要求及確認審閱結果並沒有對地下或海底設施有任行損毁機會，故發出此工作許可證。I hereby
confirm all requirements stated in item 2 (and item 3, if appropriate) have been complied and no underground & subsea utilities shall be
disturbed. I agree to issue this permit-to-work certificate to carry out the above-mentioned activity.

簽署 Signed by: ________________________/________________________ 日期 Date: ___________________

(全名 Full Name) (簽署 Signature)
本人承諾會採取一切可行步驟以確保自身及公眾人士之安全。I commit to adopt all safety measures to ensure ourselves and public are safe.
簽收 Acknowleged by: _____________________/_____________________ 日期 Date: ___________________
(全名 Full Name) (簽署 Signature)
^探孔的深度在市區至少應為 3 米或在農村地區 2 米，除非項目經理有其他書面指示。The depth of inspection pit should be formed at least 3m in
urban area or 2m in rural area unless other written instruction given by the Project Manager.
Form No. SF019 Revision 2 Page 1 of 1