Type of Works (e.g. Duct/Pipe/Cable): Estimated Length of Work (Metres): Average Depth of Excavations (Metres): Proposed Start Date: Proposed Finish Date: Hours of Night Daylight 24 Hours AM Only Working Time (Please tick) Work Lies Verge Footway Carriageway Within (Please tick) Traffic Temp. Stop/Go Road Control Traffic Boards Closure Signals (Please tick) Priority Not to Flow be Used Section 3: Details of Person/Company Conducting the Works. Copies of New Road and Streetworks cards for Operative and Supervisor (front and back) to be submitted with this form Name: Company Reg. No: Contractor’s Tel. No: Address: Name: Accreditation No: Supervisor’s Name: Accreditation No: Operative’s Section 4: Insurance Public Liability Insurance of a minimum of £10 million must be provided up to the completion of the permanent reinstatement (copy of certificate to be submitted with this form) Insurance Company: Address: Tel.No: Policy No: Expiry Date:
Type of Works (e.g. Duct/Pipe/Cable): Estimated Length of Work (Metres): Average Depth of Excavations (Metres): Proposed Start Date: Proposed Finish Date: Hours of Working (Please tick) Daylight 24 Hours Night Time AM Only Work Lies Within (Please tick) Verge Footway Carriageway Traffic Control (Please tick) Stop/Go Boards Temp. Traffic Signals Road Closure Priority Flow Not to be Used Section 3: Details of Person/Company Conducting the Works. Copies of New Road and Streetworks cards for Operative and Supervisor (front and back) to be submitted with this form Contractor’s Name: Company Reg. No: Tel. No: Address: Supervisor’s Name: Accreditation No: Operative’s Name: Accreditation No: Section 4: Insurance Public Liability Insurance of a minimum of £10 million must be provided up to the completion of the permanent reinstatement (copy of certificate to be submitted with this form) Insurance Company: Address: Tel.No: Policy No: Expiry Date:
SWL_2.docx