Classification: Internal

Health Safety & Environmental Management System

Access Permit

Stage 1: Application (To be completed by Business Partner /Tenant / Contractor / Service Provider)

Request Portfolio Commercial Residential Retail

New Permit Yes No (If Not a New Permit, Old Permit No. )
Seef Community
Entity/Mall/Community Job Location /Unit/Site

Business Partner/Tenant Arabian Souvenirs

Fattal Group
Contractor / Service Provider No. of Persons 3‐5
03/082022 10/082022
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:

Undertaking by the Contractor / Service Provider: YES NO N/A

1. Permits/certificates/NOCs & approved drawings from relevant authority are in possession during application.
2. Aware of applicable mall specific rules & HSE precautionary measures & will adhere prior to commencing works.
3. Aware & will adhere to necessary permit requirements for HSE specific tasks / guidelines / PPE needs
4. Will provide a qualified fire watch for monitoring the Impaired area(s) and undertaking letter attached.
5. Subcontractor list with copies of valid trade license are attached & will be liable for their respective activities.
6. Will report all minor or major incidents to permit issuer immediately after the occurrence.
7. All employees or workers assigned for this project are not showing any illness signs or symptoms

HSE Permit Request Confined Space Entry Working at Height (3m or more height) Mechanical Lifting
(Mark applicable task and request Hot Works Spray Painting Use/Handling of Dangerous Goods Excavation Works
for HSE Permit accordingly) Service Isolation Work with or in the vicinity of Radiation Hazard Major Demolition

Rami Al Fattal +971 55 376 6638 Signature &

Name Contact No.
Date/Time
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)

Signature HSE Permit Required?

Name
& Date (Y/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.

DHAM Version 0 AM-HSE-MP-07-F15

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