S02 Att 1f. Dig Permit SOP Form.pdf

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Z1DZ--578-26-007-FY26 Network Cable Installation
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36C25226R0013
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This document is a Standard Operating Procedure (SOP) for the Dig Permit Program at Edward Hines VA Hospital in Hines, Illinois, effective May 6, 2015. The SOP establishes a mandatory process for obtaining approval to excavate, withdraw from, insert into, or otherwise penetrate ground-level surfaces within the hospital's area of responsibility. The program is designed to minimize risk of damaging critical infrastructure and underground utilities by proactively identifying utilities in excavation areas and developing adequate safety precautions. The SOP assigns specific responsibilities to the Engineering Service Chief (annual program review and violation reporting), Project Planning Chief (official designation of Dig Permit Program Manager and impact reporting), Dig Permit Program Manager (enforcement of program requirements and violation reporting to Safety Service Chief and Project Planning Chief), and Execution Agents (compliance with all permit requirements and active participation in utility protection).

The program requirements establish a sequential process beginning with the Execution Agent's request for a Dig Permit and ending with permit closure and two-year digital record retention. Key procedural steps include issuance of Hines Form 1532, collection of preliminary information (excavation date, work area, duration), preparation of an excavation area sketch by the Execution Agent, engagement of a professional utility locator to identify all utilities within the immediate excavation area and no less than six feet beyond (marked no more than 24 hours prior to excavation), completion of Hines Form 1532 by the Execution Agent, Program Manager inspection and comparison of markings to existing utility drawings, Program Manager signature confirming maximum utility location, and final notification and permit closure upon completion of excavation work. The SOP references Hines Form 1532 (the dig permit form), OSHA 1926.651 (Specific Excavation Requirements), and USACE EM 385-1-1 (Safety and Health Requirements Manual).

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VA Hospital Engineering Service SOP Dig Permit Hines, IL 60141 May 6, 2015

DIG PERMIT PROGRAM SOP

1. PURPOSE: The purpose of this plan is to clearly define the process to obtain installation approval to excavate, withdraw from, insert into, or otherwise penetrate any ground-level surfaces within the area of responsibility at Edward Hines, VA Hospital and areas under our purview.

As underground work is carried out through the installation, the risk of damaging critical infrastructure and utilities is significant. The process defined herein seeks to minimize these risks by proactively identifying the existence of utilities in the area of excavation and affording an opportunity to develop adequate precautions to safeguard said utilities.

2. RESPONSIBILITIES:

a. Engineering Service Chief :

The Engineering Service Chief shall support the Dig Permit Program and ensure the process is kept up to date by reviewing the process and analyzing the impact on utilities throughout an execution year. Documentation is not required for this review. However, this SOP must be reviewed and dated once per year. The Service Chief shall report all program violations to the assigned PENTAD member for accountability.

b. Project Planning Chief :

The Project Planning Chief shall officially assign an official Dig Permit Program Manager. The Chief will report the impact of the program and any violations of the program requirements to the Engineering Service Chief. Should the project generating the violation be managed by the Hines Project Planning Section, the Chief shall report this violation to the appropriate contracting agency for contractor enforcement.

c. Dig Permit Program Manager:

The Dig Permit Manager shall ensure personnel involved in any work requiring participation in this permit program adhere to the requirements of the program. The Program Manager shall report any violations to the permit to the Safety Service Chief and the Project Planning Chief.

d. Execution Agent:

The Execution Agent is defined as any party partaking on actions that require this permit.

The Agent shall adhere to all requirements of the permit program and actively participate in method resolution to support the protection of underground utilities and infrastructure.

VA Hospital Engineering Service SOP Dig Permit Hines, IL 60141 May 6, 2015

3. PROGRAM REQUIREMENTS:

a. The Execution Agent shall contact the Program Manager and request a Dig Permit.

b. The Program Manager shall issue a blank permit in the form of a Hines Form 1532.

c. The Program Manager shall explain the process to the Execution Agent, and collect preliminary information from the Agent to include,

a. Expected excavation date

b. General area of work

c. Approximate duration of work.

d. Execution Agent shall prepare a sketch depicting the general area of excavation and its boundaries.

e. Execution Agent shall secure a professional utility locator vendor and locate all utilities in the immediate area of excavation and no less than 6 feet beyond the excavation area.

Utilities shall not be marked more than 24 hours prior to the planned excavation date.

f. Execution Agent shall complete the Hines Form 1532 with the exception of the Engineering signature.

g. Execution Agent will notify the Program Manager

h. The Program Manager shall inspect the markings and compare to existing utility drawings.

i. The Program Manager shall sign Hines Form 1532 confirming that utilities have been located to the maximum extent possible.

j. The program Manager shall retain a copy of the completed permit.

k. The Execution Agent shall notify the Program Manager when all excavation work is completed, backfilled and compacted (if applicable).

l. The Program Manager shall close the permit and maintain a digital copy of the permit for no less than 2 years after completion of the excavation.

4. REFERENCES:

• Hines Form 1532

• OSHA 1926.651, Specific Excavation Requirements

• USACE EM 385-1-1, Safety and Health Requirements Manual

Russell Thomason Chief, Engineering Service

DATE PREPARED

1. Clearance requested to proceed with work at on Work Order No. , Contract No. , involving excavation or utility disturbance per attached sketch. This area has has not been staked or clearly marked.

2. TYPE OF WORK INVOLVED

A. PAVEMENTS D. FIRE PROTECTION & DETECTION SYSTEMS G. AIRCRAFT OR VEHICULAR TRAFFIC FLOW

B. DRAINAGE SYSTEMS E. UTILITY OVERHEAD UNDERGROUND H. SECURITY

C. RAILROAD TRACKS F. COMM OVERHEAD UNDERGROUND I. OTHER

3. DATE CLEARANCE REQUIRED (NO LESS THAN 72 HOURS) 4. DATE CLEARANCE APPROVED (FOR P2 USE ONLY)

5. SIGNATURE OF REQUESTOR (INSTALLATION POC) 6. POC TELEPHONE NUMBER 7. POC ORGANIZATION

SAFETY

FIRE PROTECTION

GEMS

POLICE

OI&T

PAVEMENTS AND GROUNDS

ENGINEERING- HTM

ENGINEERING- PROJECT PLANNING

ENGINEERING- M&O

OTHER

11. COMMERCIAL UTILITY COMPANY

TELEPHONE

GAS

ELECTRIC

WATER

12. OTHER (SPECIFY)

14. APPROVING OFFICIAL 15. DATE SIGNED

(NAME AND SIGNATURE OF CHIEF OF PROJECT PLANNING OR ENGINEERING SERVICE CHIEF)

HINES FORM 1532, MAY 2015 VERSION

HINES ENGINEERING- DIG PERMIT

(SEE INSTRUCTIONS ON REVERSE)

9. REMARKS (USE REVERSE FOR ADDITIONAL COMMENTS)8. SERVICE/SECTION 10. REVIEWER NAME

13. PERMIT APPROVAL APPROVED DISAPPROVED

HINES FORM 1532, MAY 2015 VERSION (REVERSE)

INSTRUCTIONS

The Hine Engineering- Dig Permit is used for any work (contract or in-house) that may disrupt aircraft or vehicular traffic flow, installation utility services, protection provided by fire or intrusion alarm systems, or routine activities of the installation. This form is used to coordinate the required work with key installation activities and keep customer inconvenience to a minimum. It is also used to identify hazardous work conditions in an attempt to prevent accidents. The Dig Permit request is processed just prior to starting work. If delays are encountered and the conditions at the job site change (or may have changed) this permit must be reprocessed.

16. REMARKS (This section must describe the specific measures to be taken before and during work accomplishment. Specific comments concerning the approved method of excavation, hand or powered equipment, must be included.)

Dig Permit SOP 2015
DIG PERMIT FORM
Sheet1
Chief, Engineering Service:
DATE 1:
1 Clearance requested to proceed with work at:
Contract No:
involving excavation or utility disturbance:
has: Off
has not been staked or clearly marked: Off
2 TYPE OF WORK INVOLVED:
D FIRE PROTECTION DETECTION SYSTEMS:
G AIRCRAFT OR VEHICULAR TRAFFIC FLOW:
E UTILITY:
OVERHEAD:
UNDERGROUND:
H SECURITY:
F COMM:
OVERHEAD_2:
UNDERGROUND_2:
I OTHER:
DATE 2:
DATE 3:
5 SIGNATURE OF REQUESTOR INSTALLATION POC:
6 POC TELEPHONE NUMBER:
7 POC ORGANIZATION:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSSAFETY:
10 REVIEWER NAMESAFETY:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSFIRE PROTECTION:
10 REVIEWER NAMEFIRE PROTECTION:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSGEMS:
10 REVIEWER NAMEGEMS:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSPOLICE:
10 REVIEWER NAMEPOLICE:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSOIT:
10 REVIEWER NAMEOIT:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSPAVEMENTS AND GROUNDS:
10 REVIEWER NAMEPAVEMENTS AND GROUNDS:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSENGINEERING HTM:
10 REVIEWER NAMEENGINEERING HTM:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSENGINEERING PROJECT PLANNING:
10 REVIEWER NAMEENGINEERING PROJECT PLANNING:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSENGINEERING MO:
10 REVIEWER NAMEENGINEERING MO:
9 REMARKS USE REVERSE FOR ADDITIONAL COMMENTSOTHER:
10 REVIEWER NAMEOTHER:
11 COMMERCIAL UTILITY COMPANY:
TELEPHONE: Off
GAS: Off
ELECTRIC: Off
WATER: Off
TELEPHONE GAS ELECTRIC WATER:
12 OTHER SPECIFY:
13 PERMIT APPROVAL APPROVED DISAPPROVED:
APPROVED:
DISAPPROVED:
14 APPROVING OFFICIAL NAME AND SIGNATURE OF CHIEF OF PROJECT PLANNING OR ENGINEERING SERVICE CHIEF:
15 DATE SIGNED:
16 REMARKS This section must describe the specific measures to be taken before and during work accomplishment Specific comments concerning the approved method of excavation hand or powered equipment must be included:
2015-05-07T10:04:08-0500
RUSSELL C. THOMASON 904978

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