SASKATOON DISTRICT EXTENDED HOURS WORK PERMIT
Project
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Please Select
2800048-PAVH
2800050-La Ronge RCMP
2800051-Southend RCMP
2800052-Virtual Health Hub
2800053-RUH ICU Expansion
2820099-St. Pauls Power Plant
2820107-MN Learning-PA
2820113-SRC SXU TdDy Concrete and Steel
2820114-BourgaultMachineHQ
2820116-Cameco McArther River
2820118-St Johns Cathedral Repointing
2820119-Saskatoon City Hospital Acute Care Project
2820121-AAFC Roof Replacement
2820122-Innovation Sask Tenant Decanting
2820123-AAFC Seed Storage Building Expansion
2820124-Centre Mall Landlord Work No Frills
2820125-YXE Arrivals Renewal
2830110-Cancer Center
2840037-Theodore Spillway Upgrades
2840040-Patience Lake Injection Pump Platform
PCL Project Superintendent
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Today's Date
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/
Month
/
Day
Year
Date of Work
*
/
Month
/
Day
Year
Date
Trade Contractor
*
Projected hours of work (start)
*
Hour Minutes
AM
PM
AM/PM Option
Projected hours of work (finish)
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Hour Minutes
AM
PM
AM/PM Option
Work Authorized by:
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PCL Signature
Competent Supervisor Responsible:
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Competent Supervisor Signature
*
Phone Number (Competent Supervisor)
Please enter a valid phone number.
Format: (000) 000-0000.
Location of Work
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During the hours that a PCL supervisor is not present on site, the Responsible Supervisor noted above and the undersigned agree to accept the responsibility of:
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Ensuring competent supervision is on site at all times;
Verifying all workers on site have participatedin a site-specific PCL orientation
Enforcing PCL’s Project HSE Plan, policies, theSaskatchewan Employment Act, and Occupational Health and Safety Regulations andany other applicable legislation and standards;
Maintaining first aid coverage;
Ensuring clear delineation of work areas;
Obtaining required work permits prior to work starting (ie. Hot work, leading edge, cutting discapproval);
Ensuring the security of the site for all employees and the protection of the public; and
Confirming all site access gates are locked prior to leaving site.
Proposed Attendance: (please print full names)
Description of Work
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0/265
First Aid Equipment Location
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Type and size of First Aid Kit Required:
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Please Select
Type 2 Basic
Type 3 Intermediate
PCL Emergency Contact
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PCL Emergency Contact Phone #
*
PCL Emergency Contact
Format: (000) 000-0000.
Trade Off-site Emergency Contact
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Trade Off-Site Emergency Contact Phone #
*
Trade Off-site Emergency Contact
Format: (000) 000-0000.
Extended Hours Work Permit Criteria
Work including the Life Saving Absolute scopes of work must have PCL representation on site as well as competent trade supervision at all times
Multiple trades on site require additional co-ordination when considering extended hours permits.
Copies of the permit are to be kept by the PCL Superintendent and posted at the entrance of the work area.
Email (A copy of the approved permit will be sent here)
*
example@example.com
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