BHA Extended Hours Work Permit

Extended Hours Work Permit
PCL Superintendent*
Today’s Date*

MonthDayYear
Date
Project Name*
Project #*
Date of Work*

MonthDayYear
Date
Subcontractor*
Projected Hours to Work: blank* am to blank* pm.
Applicant Signature*
Applicant Name*
Applicant Email*
Foreman Responsible for Supervision*
Trade*
First Aider on Duty*
First Aid Certification Level*
During the hours that a PCL supervisor is not present on site, the undersigned agrees to accept the responsibility of:
- Enforcing PCL’s Project Safety Policy, and the Occupational Health and Safety Act;
- Maintaining first-aid coverage; and
- Ensuring the security of the site for all employees, and the protection of the public.
Note: A PCL Superintendent must approve all after hours work where there will be no direct PCL supervision only after identifying, assessing and controlling for any risk associated with the work. Additionally, if there are 2 or more trades working on the site, then direct PCL supervision is required.
Name of Workers*
Name of Workers
Name of Workers
Name of Workers
Name of Workers
Name of Workers
Area of Work*
Office Emergency Contact Name*
Phone Number*
Format: (000) 000-0000.
cc: Security (check if yes)

Option 1Option 2Option 3
Approved by (PCL Superintendent)*
Date of Approval*

MonthDayYear
Date
Should be Empty: