Extended Hours Permit

SASKATOON DISTRICT EXTENDED HOURS WORK PERMIT
Project
PCL Project Superintendent
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date of Work

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Trade Contractor
Projected hours of work (start)

Hour Minutes

AM/PM Option
Projected hours of work (finish)

Hour Minutes

AM/PM Option
Work Authorized by:
PCL Signature
Competent Supervisor Responsible:
Competent Supervisor Signature
Phone Number (Competent Supervisor)
Please enter a valid phone number.Format: (000) 000-0000.
Location of Work
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:
Proposed Attendance: (please print full names)
Description of Work

0/265
First Aid Equipment Location
Type and size of First Aid Kit Required:
Designated First Aid Person
PCL Emergency Contact
PCL Emergency Contact Phone #
PCL Emergency ContactFormat: (000) 000-0000.
Trade Off-site Emergency Contact
Trade Off-Site Emergency Contact Phone #
Trade Off-site Emergency ContactFormat: (000) 000-0000.
Criteria of a Competent Supervisor
A competent supervisor shall be a person who possesses the following:
- Leadership for Safety Excellence or other suitable supervisory training equivalent
- Current appropriate level of first aid training
- Working knowledge of the items detailed below (to be covered in Supervisor Site Orientation):
  - Site specific emergency response requirements for first aid, environmental spills, fire/flood/power failure, unauthorized entries to site
  - Location of SDS for all products on site, current copy of PCL project specific safety plan, current copy of SEA and OH&S Regulations
  - Site extended hours work program
  - Project team contact numbers and district emergency contact numbers
  - Site security plan and site open and close up procedures
  - Trade contractor check in and check out procedures
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.

All PCL Superintendents are to be available by phone/email during and after hours in the event of an emergency or situation on site. Where the Superintendent cannot be available, they may designate an alternate competent Supervisor. This person’s information must be communicated to the project team and required district senior management.

Prescribed Duties of Prime Contractor
• Ensure that all activities at the required worksite that may affect the health and safety of workers or self-employed persons are coordinated
• Identify a competent person to oversee and direct, on behalf of the prime contractor, the activities of employers, workers and self-employed persons at the required worksite
Email (A copy of the approved permit will be sent here)
example@example.com
Should be Empty:

SASKATOON DISTRICT EXTENDED HOURS WORK PERMIT

Criteria of a Competent Supervisor

Extended Hours Work Permit Criteria