<p> Rail Design Request Form</p><p>Attention: MGF DESIGN SERVICES LTD Tel: 01942 402 704 Fax: 01942 402 766 Email: [email protected] General Details Preferred Contact for Design: Phone call prior to starting design: Status of scheme: CRM Project Ref (MGF):</p><p>Rep Customer Yes No Live Tender </p><p>MGF Representative Name: Date requested: Date design required: Date kit required on site:</p><p>Customer: Main Contractor & Client:</p><p>Site: Scheme title:</p><p>Site Contact (name): Tel: Email:</p><p>Temporary Works Co-ordinator (name): Tel: Email:</p><p>Contractor’s Responsible Engineer CRE (name): Tel: Email: (responsible for the Temporary Works) </p><p>Excavation details (All dimensions are in metres) Note: Please provide all relevant drawings including GA, section(s) plus any other as appropriate. If none available, Scheme Type: provide detailed hand sketches.</p><p>Cofferdam Single sided Trench Frame only Other (state) </p><p>Excavation depth: Over-dig included? Plan dimensions: Sheet to Yes No she et Muck to muck Inside (Note: 0.3m recommended) fra me( s) Clearance required below lowest frame/strut: Clearance required between frames/struts (in plan): </p><p>Ground Conditions Ground conditions described by: (indicate documents attached) SI Report BH / TP Log BH / TP Location Plan Verbal Soil Description Other (state) </p><p>Note: For verbal soil descriptions use Verbal Soil Description Form ED/QF002. MGF cannot provide cantilever solutions without a relevant Borehole. Nearest BH/TP: Distance from excavation: BH/TP Datum: Commencing Level:</p><p>Existing GL: Existing Slope: Topsoil Strip / Ground reduction / Batter (details):</p><p>Document is uncontrolled when printed. Printed copies are for information only. Page 1 of 4 Rail Design Request Form</p><p>Groundwater Level: Piezometer Readings: Local Influences (e.g. Well Pointing? tidal/flood): Yes No Level: </p><p>Document is uncontrolled when printed. Printed copies are for information only. Page 2 of 4 Rail Design Request Form</p><p>Additional Information Note: Please provide photographs of the site in support of the below information where possible. External Loading (Plant /Site traffic): At Distance:</p><p>Up to 30Te Up to 45Te Up to 60Te Other (state) </p><p>Adjacent Structures / Cranes / Roads / Railways / Embankments / Water Courses / Spoil / Materials: At Distance:</p><p>Adjacent Services / Infrastructure/ Overhead Cables: At Distance:</p><p>Anticipated duration of excavation: Notes: < 6 weeks < 12 weeks > 12 weeks</p><p>Are the Temporary Works to be installed during a full rail track possession? Yes No Details if No: </p><p>Are the Temporary Works to be subject to live rail loadings? </p><p>Yes No Details if Yes: RU Loading (50kN/m²) RL Loading (30kN/m²) Other: </p><p>Are any residual risks identified by permanent works designer or construction team for consideration in the Temporary Works Design? Yes No Details if Yes: </p><p>Are there any restraints regarding deflection or settlement? Yes No Details if Yes: </p><p>Is the Form 2 for the Permanent Works Available? Are there photos of the Temporary Works location? Yes No Yes No Method of Working Installation of sheets (method): Using (machine type): </p><p>Pre-Drive Dig & Push Slit Trench Dig & Drop Excavator Hammer Other (state) </p><p>Maximum (anticipated) achievable Construction sequence: toe: Leap frog frames 2 stage construction (concrete base thickness )</p><p>Preferred solution: Boxes Sheets & Frame(s) Cantilever sheets Back to back frames Knee braces Cross struts </p><p>Safety Ancillary’s (Edgesafe, Laddersafe, Davit) Other (state) GRiPSHORE Preferred solution:</p><p>Trench Boxes Modular Boxes Vertishore Vertishore c/w Backing Boards Sheet & Waler(s) Network Rail Approval Note: Please confirm if this design is subject to Network Rail Approval and if MGF are required to complete a F002 and/or F003 for the Temporary Works. Please be aware that MGF will require a minimum 5 working days to complete F002/F003 from receipt of full and final information. Documents to be completed by MGF:</p><p>F002 (Statement of Design Intent) (Note: £300 Design Charge)</p><p>F003 (Certification of Design) (Note: £650 Design Charge)</p><p>Network Rail Design Check Category (if known): Category 0 Category I Category II Category III </p><p>Document is uncontrolled when printed. Printed copies are for information only. Page 3 of 4 Rail Design Request Form</p><p>Notes e.g. Preferred Equipment/ Loading from Additional Rail Plant</p><p>Supporting Information Checklist (Please indicate documents attached with this Design Brief) Relevant Drawing(s)/Sketch(s) Details of Ground Conditions Photographs of Site</p><p>Permanent Works F002 Latest Revision of ‘For Construction’ Permanent Works Drawings</p><p>Customer Confirmation (To be completed by the Temporary Works Co-ordinator or the CRE) I confirm that the above information comprises the design brief, which should be used to prepare a Signed (by customer):temporary worksName shoring (print): scheme. Title: Date:</p><p>Document is uncontrolled when printed. Printed copies are for information only. Page 4 of 4</p>