Movement of Materials and Static Loading

Transport for London

London Underground

F0654 Movement of Materials and Static Loading on escalators, Lifts& Moving Walks: Application form

Material Movement Application Form
LOG No. :-
London Underground Ltd
4th Floor , Griffith House
280 Old Marylebone Road
London
NW1 5RJ / Material Movement
Application
This form must be completed in block capitals. Please note all details must be supplied unless N/A.ALL PARTS WITH # MUST BE FILLED IN
To: Notified Person – London Underground Ltd
Company/Sub Contractor: #…………………………………….
From: #…….…………...... Date: ......
(contractor/LUL business unit)
Telephone: ...#...... Fax: .#......
We hereby apply for authority, in accordance with engineering standards 1-092 & 1-093, to move long bulky material using lifts or escalators as detailed below or to erect a scaffold within an escalator shaft as detailed below. All Staff carrying out the works have been made aware of the requirements of LUL CAT1 Standards 1-092 and 1-093.
Station:#………..…...... Lift/Escalator *No .#......
(* delete as appropriate) (No. Must be entered)
Description of Works:#
Description of Material:
Dimensions:
Length: ..#...... Height: #...... Width: .#...... Weight: .#......
Height of Centre of Gravity: .#...... Quantity: .#......
Description of Scaffold or Working Platform to be erected in Escalator Shaft:
Dimensions (please attach a sketch):
`Overall size: Number of Steps being used: Load on Steps:
Programme:
Start Date:#
Finish Date # Time : #
Responsible Manager :
Name:# Grade:# Telephone Number #
Lift and EscalatorMachineChamberAccessPass Details:
Name of Site Person in Charge:#
Endorsements# Pass No. # Expiry Date:#

Form No. :-

Asset Performance, Lifts & Escalators. / Material Movement
Application
Page 2 of 2
Proposed Method of Working:#
(should be entered on all applications)
Number in Gang: ......
Has a formal manual handling assessment been carried out: yes/no (delete as appropriate)
Signed: ..#...... Date:- .#......
Allow at least five working days for the approval of this application, unless otherwise agreed.
Approval:
To: Contractor / LUL Business Unit
From: L & E Inspection Services –
Signed: ......
Date: ......
Comments:
Please ensure that all paperwork is read with this licence and all contractors must work to LUL CAT1 Standards at all times whilst they are carrying out Movement of Materials activities. This licence must be in the possession of the operative controlling the movements at all times.
This form must be forwarded to the Line Works Planner for the booking of possession of the lifts or escalators referred to above.This authority must be shown to the Station Supervisor when seeking a permit to enter.

)

Used in conjunction with:LF26 / Date: 30/03/2012 F0654A2

MAYOR OF LONDON Page 1 of 3