Transdev - LUAS - Work Request Form

Transdev - Work Request Form

For work on or near LUAS

Section 1Complete all fields in this section

Name and address of Applicant:

Company:

Name:

Address:

Phone No Office Hrs:

Outside Office Hrs:

EMail:

Name and address of organisation carrying out work on behalf of Applicant:

Company:

Name:

Address:

Phone No Office Hrs:

Outside Office Hrs:

EMail:

Section 2 Details of work being carried out (Please provide as much information as possible)

Do you have a Competent person with a LUAS safe work pass (provide pass number):

Do you have a Competent person with a LUAS safe work pass (provide name):

Please indicate if the proposed works will result in a material change to the LUAS System:

Yes No

Please provide a Name(s) & Site Contact Phone number of the person(s) on site (24 hours):

Contact Name(s):

Contact Phone(s):

Please indicate which LINE work will take place on:

Red Line Green Line Both

Start Location:

Please fill in a Start Location

End Location:

Please fill in an End Location

Please provide the details of the consent under which these works are to be undertaken:

Exempt from requirement for planning permission:

Yes No

Planning Authority:

Please fill in a Planning Authority

Please fill in a Register Reference No

Description (Please specify the exact description of works):

Please provide the following when submitting the application:

A method statement and risk assessment detailing how the work is to be carried out and how the risks will be mitigated.

A copy of insurance schedule.

A copy of planning permission(s).

Section 3Details of time and type of request

Proposed Start Date:

Proposed End Date:

Please tick type of request required:

Occupation Possession Possession with Isolation

Please select a permit type

Section 4Complete all fields in this section

The Applicant hereby applies for permission to carry out the works described above. The Applicant acknowledges that applications and permits may be subject to charges, payable by the Applicant. The Applicant will hold Transdev Dublin Light Rail Ltd. harmless with regards to any damage or loss incurred due to the works including, but not limited to contractual penalties. This application does not remove the requirement on the applicant for any other statury approval. Sumbission of this form by electronic transmission will be taken as agreeing to this and conditions as may be detailed by the LUAS Operator.

VAT Registration Number:

Application Date:

Section 5Excavations

Will there be any excavations on site?

Yes No

Maximum depth of excavation (mm):

Width of excavation (mm):

Distance to nearest rail (mm):

Method of excavation:

Handtools Excavator

Size of excavator (Tonne):

How many OCS poles within 3m of excavation:

Section 6Rail Limits

Will you be operating Road/Rail vehicles on the track?

Yes No

Which type of vehicle is required?

Rail Road Both

Vehicle limits Rail Vehicle Road Vehicle

Axil load of vehicle (Tonne)

Max height of vehicle (mm)

Centre to Centre (mm)

Back to back (mm)

Max Gradient (%)

Miniumm radius of curvature (m)

Cant effiency (mm)

Section 7Attachments

Please ensure you have provided the minimum information required:

Method Statement
Risk Assessment
Confirmation of insurances
Copy of planning permission(s)
Rail vehicle certificate
Any other relevant information

Information

OCCUPATION

Is required for works outside the swept path which may import risk to the tramway.

POSSESSION (NO ISOLATION)

Is required for any works within the swept path but more than 2.75meters from the OCS or it’s supports or within pits/ducting.

POSSESSION ISOLATION

Is required for works within 2.75m of the OCS or in pits containing voltage greater than 230v AC or DC