Classification: Internal ACCESS PERMIT Permit
No.
DI/HO/2021/85
Stage 1: Application (To be completed by Business Partner /Tenant / Contractor / Service Provider)
Request Portfolio Commercial X Residential Retail
New Permit X Yes No (If Not a New Permit, Old Permit No. )
DIC
Entity/Mall/Community Job Location /Unit/Site
DU/CCSI Blg No:1
Business Partner/Tenant DIC POP
CCSI/OCS/Filicom 2
Contractor / Service Provider No. of Persons
3/14/2021 4/8/2021
Permit Validity (Date & Time) From To
Material Move-In/Out Major Fit-out Works Minor Fit-Out Works
Permit Required for (mark X) Minor Demolition Entry to Critical Zone FM Services
Working at Night Working on Roof Top Others
Brief description of the Job:
Site Survey, Cabiling,Fiber Preparation and Patching
Kindly Permit access for bringing Laptop inside DC
Undertaking by the Contractor / Service Provider: YES NO N/A
1. Permits/certificates/NOCs & approved drawings from relevant authority are in possession during application. N/A
2. Aware of applicable mall specific rules & HSE precautionary measures & will adhere prior to commencing N/A
works.
3. Aware & will adhere to necessary permit requirements for HSE specific tasks / guidelines / PPE needs N/A
4. Will provide a qualified fire watch for monitoring the Impaired area(s) and undertaking letter attached. N/A
5. Subcontractor list with copies of valid trade license are attached & will be liable for their respective activities. N/A
6. Will report all minor or major incidents to permit issuer immediately after the occurrence. N/A
7. All employees or workers assigned for this project are not showing any illness signs or symptoms N/A
HSE Permit Request Confined Space Entry Working at Height (3m or more height) Mechanical Lifting
(Mark applicable task and request for Hot Works Spray Painting Use/Handling of Dangerous Goods Excavation Works Service
HSE Permit accordingly) Isolation Work with or in the vicinity of Radiation Hazard Major Demolition
SHILPA.T.G 586975626
Signature &
Name Contact No.
Date/Time
3/14/2021
IMPORTANT NOTES:
1. This Permit has been issued on the request of the Applicant and does not relieve the Business Partner or the Contractor appointed by them from any legal
and/or contractual obligations.
2. This permit is deemed to be cancelled and the works will be stopped immediately on any Health & Safety or other violations on site noticed during the
inspections or notified to the Facilities Manager or building security.
3. The applicant is fully liable for any penalties, rectification / cost implication of any damages and interruptions caused due to such violations by the
contractor and their subcontractors. The works can be resumed only after necessary corrective actions.
4. Any noisy or malodourous activities such as drilling, coring, painiting, drainage terminations etc. are permitted only after working hours and the applicant
to coordinate with the building security for the same to avoid stoppage of works.
5. Any works on existing building services and systems such as MDB/SMDB modifications/terminations, Fire Alarm & Fire Fighting, Emergency Lighting, BMS,
HVAC Controls etc. must be carried out through the FM Service Provider only.
6. Contractors to produce Fit-out Completion Certificate issued by DDA prior to occupying for operating the unit.
7. Applicant shall take adequate control measures & provide qualified fire watch(es) for monitoring affected areas in event of Fire Detection and/or protection
system impairment. Fire watch(es) shall be in place till impaired systems are re-instated to satisfaction of Facilities Manager / FM service provider.
8. Applicant shall conduct Tool Box Talks to their work force daily basis to brief work place and task related risk controls and building emergency response.
Such shall be recorded and evidenced to HSE/Security/Permit Issuer whenever required.
Stage 2: Endorsement (To be completed by the Facilities Manager/Mall Manager/Authorized Representative)
HSE precautions must be followed
Any high level work need HSE permit
Signature HSE Permit Required?
Name Mohammad Haseeba & Date (Y/N)
N
Stage 3: Access Confirmation (To be completed by Building Security)
Signature
Name No. of Passes issued
& Date
General Notes:
1. Stage 1 of this permit request shall be duly filled and signed by the applicant, after complying with the undertaking requirements.
2. Copy of NOCs and valid permits must be available in the vicinity of the job for verification during inspections.
3. The renewal of the permit after its expiry is subject to the evaluation of the work status and requirements only.
TEC-BFM-F24 Page 1 of 1 R8 – 5 Jan 2021
