General Permit To Work Form
PERMIT TYPE: GENERAL PERMIT Permit No:
1.1 Building Name:
Ocean Heights Date of request :
05/07/2025
1.2 Permit Requester: Muhammad Rafiq Noor Mobile No.: 052 702 2121
Tenant Details (if applicable) Apartment No: 5901
1.3 Work Executed By: Facility Management Appointed Contractor
1.4 Contractor Company Name: Contact Person:
Shahid Charag Din Technical Services LLC 052 702 2121 Mobile No:
1.5 DAMAC Living App request No Work Location: Inside Apartment
1.6 Work description
AC Fan Motor Repair
1.7 Work execution Start Date: as Expiry Date: 08/07/2025
05/07/2025
Time : 9am Time:
1.8 No. of Workers : 4 No. of Supervisors: 1
2. POTENTIAL HAZARDS/ RISKS
Check (x) All Potential Hazards/ Risk Impacts As Applicable:
Working at height Extremes temperature Mechanical equipment Entry to plant rooms Power tools
Noise Entanglement Lighting Slip, trip and fall Electrocution
Falling objects Use of Chemicals Moving equipment Use of ladders Pressurised Line
FLS system Live electrical work Traffic Manual Handling
Other Anticipated Hazards (specify):
3. RISK CONTROLS
3.1 General List of HSE Precautions & Controls
MSRA Approved Supervisor on site Barricading and sinages HSE inducted Storage of Material
Floor protection Valid EID Coverall/uniform Steel toe shoes Safety helmet
Safety gloves Goggles or face shields Ear plug Dust mask Safety vest
Safety harness Spill Kits Bunks man Training certificates Gas Monitoring
Life Jacket LOTO FLS system Impairment House keeping
Other Anticipated Hazards (specify):
4. Declaration:
I hereby agree that all the safety requirements and all necessary precautions has verified. The work will be performed as approved & no
other scope /work will be carried out other than what mentioned in the checklist and the permit.
Valid machinery operators’ certificate from ENAS/ EIAC accredited Third party Contractor’s valid license
Method of Statement and Risk Assessment SDS of all chemicals
Valid certificates from EIAC accredited Third party Engineered Drawing
NOC/Modification Permit from Fit out dept, DXB Civil Defence Other (specify):
Signature &
Permit Requester Name: Muhammad Rafiq Noor Designation:
Supervisor Date:
Designation: Signature &
Permit Initiator Name:
Mubarak Ali FM Supervisor Date:
Signature &
Permit Issuer Name: Designation
Sumesh Subhash FM Manager Date:
LOAMS-OPS-FOM-57, Rev 01, 01/06/2022 Page 1
General Permit To Work Form
5. Permit Close-Out:
Job Completed Suspend Cancelled
Close-out Date and Time:
The work in the above location is completed. The work area/adjacent areas inspected and found safe. All materials have been removed and waste
materials disposed of as per HS&E requirements (Proof attached). ALL of these conditions have been met, this PTW is now close-out.
Permit Requester Permit Issuer
Name: Muhammad Rafiq Name:
Designation : Designation :
Supervisor
Date : Date :
05/07/2025
Signature: Signature:
Close-out Remarks:
SPECIFIC HSE INFORMATION AND RULES
The Staff/Tenant/Contractor shall adhere to the following Health, Safety & Environmental rules listed below. Inclusive of, but not
limited:
1. Obey all local authority HSE rules and regulation.
2. Employer should, by law, need to provide Personal Protective Equipment to their workers, i.e. hard hats, gloves, high
visibility vests, safety Harness, Safety Shoes etc. Make sure workers are using them;
3. The correct PPE must be worn at all times, Additional PPE will be required in accordance with individual Method
Statements and COSHH recommendations.
4. Work in accordance with accepted safety practices.
5. Report unsafe working conditions and/or practices to supervisors immediately to the FM Team
6. Use correct and suitable tools, and ensure proper care is taken.
7. Obey instruction from the FM, HSE and Security team always
8. All works shall be carried out as per approved Method statement and Risk assessment and competent supervision.
9. Portable electric tools and equipment shall only operate with adequate safety measures such as safety guard, proper
electrical cables and PPE. All electrical cables and connections shall be secured at all times;
10. Proper Housekeeping must be followed
11. Ensure adequate barricading and signage in the work area until the work is complete
12. Anybody found to be under the influence of alcohol or drugs will be penalized and removed from the property
13. Fighting, Horseplay or other unprofessional actions which put other people’s safety at risk will not be tolerated.
14. The use of abusive language or making excessive noise is prohibited.
15. Smoking is prohibited except in specifically designated smoking areas. Any person found smoking in restricted areas is
liable to be permanently removed from the property and to be penalized.
16. Approved PTW form must be submitted to security department prior to the start of work and No any work shall be
carried out without any approval
17. Copy of the work permit shall be placed in the work place or presented to the HSE/Security personnel upon their request
18. In the case of any emergency, Contact Security team
19. The PTW needs to be closed out, any failure shall leads to penalties/fines as per the DAMAC policies and may in future
the contractor shall be banned to enter in DAMAC premises
I read the above instructions and will brief our workers to ensure they strictly abide by the above rules and regulations.
Permit Requester Name: Muhammad Rafiq Designation: Supervisor Signature:
LOAMS-OPS-FOM-57, Rev 01, 01/06/2022 Page 2
