To:
Date:
2014
“Permit to Enter” Application Form
(Supplying ALL information will assist with the Permit Process)
Your Company Purchase Order No: ______________________________
KiwiRail Reference No (if relevant):
______________________________
1.
Company Name and Full Address: ______________________________________________________
_____________________________________________________________________________________
Contact Name:
_______________________________________________________________
Contact Telephone #’s: work DDI
mobile
fax
Email:
_______________________________________________________________
If there are other contractors / subcontractors involved please name them and provide a contact number
_____________________________________________________________________________________
2.
Exact location of work (Address with other nearby streets & intention of how to access area)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
(Attach a map/sketch if more appropriate for site/job clarity to help hasten your Permit application)
3.
Brief overview of the work to be carried out, your distance from any tracks and Minimum Approach
Distance (MAD) to the overhead lines and equipment (NB. Anything of a permanent nature – in, under
or over the rail corridor) i.e. new bridge, new level crossing, new cabling must be authorised by KiwiRail
first i.e. Property Office 04 474-2333.
Note:
a. All excavations will require cable locations and require a minimum of 15 working days notice
b. Should protection personnel be required, be prepared for delays – please give as much notice as
possible for your work requirements, at least 15 working days notice
c. Any work within the MAD or cutting of the rail will require a Permit to Work. This takes 10 working
days and will be issued from the KiwiRail OLE Project Manager
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
(Continue on a separate sheet if required – supply relevant documentation e.g. Copy of Grant, written
clarification from NZRC (KiwiRail) of work validity). All applications require a SITE SPECIFIC
SAFETY PLAN & METHOD STATEMENT, along with Construction Plans, Photos, Maps of your
intended worksite
4.
Estimated start and finish dates, daily start and finish times for your project and if it is weather dependant (to
help avoid delays please give at least 20 days notice of work commencement)
_____________________________________________________________________________________
5.
Name and Mobile phone number of a person in authority on site
_____________________________________________________________________________________
6.
Alternative dates for the work ____________________________________________________________
7.
E-mail, fax or post all information to (e-mail preferred):
KiwiRail Network
Fax: 09 270-5228
PO Box 22-043
Email:[email protected]
Auckland 1640
8.
All information will be appropriately assessed then applied to a Permit to Enter. Please read all
documentation carefully. Any queries please phone : Aaron Hermond 09 270-5248 or 0272 026 609.
OMF-AD-0029
Date: 13/03/2014
Rev: 3
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