Close Approach Permit

Permit issued to:

Full legal name*

First NameLast Name

Company name*

Position held at company*

Email*

example@example.com

Contact phone*

Area CodePhone Number

Work details

Job address / street address*

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code

Work start date*

Date

Work end date*

Date

Location Details e.g. Between pole/transformer number or street number*

Attachment 1

Please describe the work being done onsite

Select all site activities that apply*

Use of cranes and other machinery near overhead power linesExcavation near strategic underground cables of equipmentExcavation within 4m of electricity polesVegetation/Tree Trimming near overhead power linesOther

Atttachment 2

On Site Contact Details

Site supervisor name*

First NameLast Name

Phone contact number - must be available 24/7*

Area CodePhone Number

General Permit Conditions

1. Close Approach Permits shall be treated as formal notification that Counties Energy Ltd has granted permission for the permit of the applicant or site supervisor as named on this form (non-electrically competent person) only to work in proximity to Counties Energy's network with reduced minimum safe approach distances (M.A.D) as specified within the issued permit.

2. All Power Lines are to be treated as 'live' at all times. All workers shall observe the - Minimum Approach Distances (M.A.D) from power lines shown within an issued permit. The 'Minimum Approach Distances (M.A.D)' are the minimum distances under ideal environmental, weather and working conditions.

3. Permission will be granted in accordance with requirements of the SM-EI, NZECP 34 and the Worksafe – ACOP Maintenance of Trees Around Power Lines and under strict observance of any restrictions and conditions specifically identified within the issued permit.

4. Advice shall be given to the Counties Energy Network Operations Centre (NOC) at the commencement and completion of work each day. Phone 09 238 1764.

5. The site Supervisor is responsible for compliance with all relevant Acts and Regulations and is to remain on site when mobile plant is within 4.0 meters of the overhead lines.

6. A Safety Observer is required when any part or attachment of mobile plant is within 4.0 meters of all overhead lines. Responsibilities of the Safety Observer are to monitor the working distance between the device and the lines, maintaining communication with the operator of the plant at all times to warn them when the approach distance restriction could potentially to be exceeded. The communication method must be heard and acted upon over all other distractions and/or noises throughout the monitoring period.

7. If required as a condition of this permit, please allow 3 working days to arrange for a Counties Energy Safety Observer to be assigned to site.

8. The issued permit is not transferable to any other individual or organization not named in the issued permit. Only the site supervisor can be changed, once you have formally informed Counties Energy NOC.

9. The issued permit shall be held onsite during work activities. It must be available to be inspected at any time by a Counties Energy employee or nominated representative.

10. Any hand-written changes on an issued permit will automatically 'cancel' the permit.
11. Counties Energy reserves the right to cancel a permit at any time where the Applicant or Site Supervisor is found to be in breach of any of the permit conditions.

12. Any overhead line or underground cable contact is to be reported to Counties Energy NOC immediately. Counties Power NOC Emergency phone 09 238 1764.

13. A Warning Notice 'WARNING, KEEP CLEAR OF POWER LINES' shall be placed as near as practicable to the mobile plant operator's position.

14. If any work involving excavation or interference of land is within 8 meters of a pole or stay wire of an overhead electric line the work must comply with NZECP 34 section 2, otherwise permit shall be required in writing from the line owner. NZECP34 can be downloaded free from here.

15. Any excavation near Strategic Underground Cables or Equipment closer than the 'M.A.D' must be dug by hand and supervised by Counties Energy or one of Counties Energy's approved Safety Observers.

16. The maximum allowable period for the issue of a close approach permit is between the applied start and completion date. However, where the worksite significantly changes during the course of the work being undertaken (in terms of the location or work conditions or operator applied safety measures are applied) the maximum allowable period for the issue of permit is 48 hours.

Authorisation

If my permit is approved, I accept and agree to all General Permit Conditions listed aboveI understand that if the site supervisor or any other job details change, the duty operator must be advised immediatelyIf my permit is approved, I will take personal responsibility for briefing the designated site supervisor on all aspects of the permit and ensure that they fully understand theseI /We accept all responsibility and agree to pay full cost for any damages on the Counties Energy network caused by works undertaken by myself, my team or the Company as named in this application.If undertaking works for a company, in submitting this application, you confirm that you have the necessary financial authority to accept such conditions, and potential costs incurred.