Permit to Commence Work (PERCOW)

PERCOW ID

All contractors must complete this Permit and have it approved before commencing any work on Airport Development (ADG) sites. The purpose of this Permit is to ensure that all safety and contractual aspects of the works have been considered and actioned.

Are you or your business registered with ADG? *

YesNo

Note: registration is necessary before any work on ADG Leased Area is permitted.

*Please register your business with ADG before proceeding. Click here to register

Part 1 – Application Details

Date

Applicant Name *Person in Charge of Works

Phone *

Business Name *

Email *

Contractor WHS Advisor *

Contractor WHS Advisor's phone *

ADG Authorised Person's Email *

ADG Authorised Person's Phone *

ADG Project Manager Email *

Other PM Email *

Have you completed the Working on Airport induction? *

YesNo

*Please complete the Working on Airport induction before proceeding with the application.

Part 2 – Description of Works

Address of Works *

Is access to the security restricted area required? *

YesNo

Start Date of Works *

End Date *

*Error!!! End date should be after the start date of works.

Hours of work (From) *

Hours of Work (To) *

ABCO Reference Number *

Describe the planned works *

Date Validation

Will you be installing temporary fencing? *

YesNo

Part 3 – Acknowledgement of Applicant

I recognise my obligations under the Work Health and Safety (NationalUniform Legislation) Act 2011, associated legislation and codes of practice and am committed to provide and maintain a safe and healthy workplace when working on the ADG sites. This commitment extends to our own and ADG staff, clients, visitors, subcontractors and the general public.We have conducted a risk assessment for all the high risk activities that will be undertaken on this project by ourselves and our subcontractors and have documented this in our WHS (Work Health and Safety) Management Plan/Safe Work Method Statements for this project.All our staff and subcontractors have been involved in this process and instructed in what role they will play in the management of safety on the project. *

To manage the safety on this project we:

Have assigned WHS responsibilities to supervisors, staff and subcontractors working on this project. *

Have adequate WHS consultation forums in place throughout the project enabling all staff and subcontractors to raise and manage WHS issues on the project. *

Will provide a Contractor Monthly WHS Report outlining our WHS performance over the previous month and issue to the ADG Authorised Person and a copy to the Health & Safety Manager. *

Will report all accidents, incidents, near misses, hazards, property damage, spills or aerodrome events as soon as they occur to the ADG Authorised Person and the Health & Safety Manager initially by phone and a follow up in writing on the appropriate event notification forms. *

I acknowledge and confirm that the above actions will be implemented on this project and will provide documentation to the ADG Authorised Person and Health & Safety Manager as required to verify the same. *

Name of Applicant *

Date and Time

Part 4 – ADG Special Conditions

Standard Special Conditions

Contractor must not interfere with the day to day operations of ADG.
Contractor must leave the site and surrounding areas in a clean and tidy condition at the end of each day to ADG approval.
Any damage to ADG property caused by the Contractor must be rectified at the Contractors expense to ADG’s approval.
Environmental controls shall be implemented as per the Construction Environmental Management Plan (CEMP) approved bythe ADG Environment Manager.
All relevant permits must be approved before works commence.

Additional Special ConditionsOther special conditions specific to the work being undertaken:

Part 6 – Authorisation to Work

Is the permit approved? *

YesNo

Reason for disapproval/ Notes to the applicant *

I authorise the works listed above to proceed during the specified dates and times, in accordance with the ADG special conditions noted in Part 3 above. *

Name and Title of ADG Authorised Person *

Authorisation date and time *

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