27o-Open-Hole-Grating-Permit

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					                                                                                                           ATTACHMENT O
                                                           UNITED
                           GRATING REMOVAL/ OPEN HOLE PERMIT


Contractor:_______________________________ Date _________________ Starting Time:_______________

Location: __________________               ___________         Extended Dates: From: ____________          To :___________

Nature of Work:____________________________________________________________________________

_________________________________________________________________________________________


Grating may only be removed when the employees are equipped with fall protection, safeguarding / barricading for the hole
is provided and warning signage is in place.

Hole Watch               Yes / No                 Barricades                 Yes / No           Hole Cover        Yes / No

Safety Harnesses with twin lanyards and shock absorbers Yes / No             Anchorage          Yes / No

Signage - "DANGER– OPEN HOLE PROTECTION - DO NOT REMOVE"

Hole must be covered or barricaded. Hole cover must be anchored / secured.

Open hole cover must be of substantial material. Minimum - 25 mm undamaged wood.

Approval to remove the grating:

Construction Superintendent: ___________________________________________ Date:_________________
                                         (Print name and sign)

ATTACH AREA PLOT PLAN INDICATING THE EXCACT LOCATION WHERE THE GRATING HAS TO BE
REMOVED.

Joint Jobsite Visit after grating has been removed and cover / barricading is in place. By signing below the parties verify
that the area is safe and that all requirements have been met.

Field Supervisor ____________________________________                           Date: ________________      Time: ________

Safety Supervisor: __________________________________ Date: ________________                                Time: ________


                                                 RESTORING OF WORK AREA

Grating put in place, clips attached                     Yes            No

If "no," is in the following condition: _____________________________________________________________

Hole filled in:                                  _____ Yes        _____ No

If "no," is in the following condition: _____________________________________________________________

Contractor Safety:                                _______________        Date    ____________

Field Supervisor:    _____________________________________                       Date: ______________



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