PM:

GENERAL ACCESS PERMIT Department GS Permit

Name: Number:

DECLARATION
Gencrest issues this permit for the execution of work by the named below. Gencrest Plant Head before work commences. All works must be strictly controlled to reduce any
risk of injury or damage to property. The contractor must comply with Gencrest Health and Safety Policy and current legislation, including relevant Codes of Practice.
Precautions must be taken by the contractor to ensure the safety and security of the work area including warning notices, cordon tape, bollards and personal protective
equipment. On completion of the works a senior representative of the contractor must notify an appropriate Gencrest representative that works are complete or otherwise, that
the contractor's team is leaving the premises; all passes must be handed in at that time. The contractor accepts full responsibility for any damage c aused to other services or
finishes while working in the building. All fields of this permit must be completed. Requirements listed in sections (iii),(v) or (vi) below, a General Risk Permit MUST also be
completed: Method Statements, Risk Assessments, COSHH Sheets and drawings to be attached as appropriate

SUBMISSION REQUIREMENTS:
I. Indicate into which building you require access:

This permit is
at
submitted on:
II. State on which floor(s) and location on floor:

Complete the date/time table below for each day of the works.
(No more than 7 days per permit application)
Day Date Start Time Finish Time Review Sign III. Will you require access into any of the following?
1 Computer Rooms YES:
2 I.T. Data Cable Riser Cupboards: YES:
3 Mechanical or Electrical Plant Rooms: YES:
4 Mechanical or Electrical Riser Cupboards: YES:
5 Areas designated “Restricted Access”: YES:
6 IV. Will a Security escort be required: YES:
7 Will a Engineering escort be required: YES:
Details Will a Tech/Systems escort be required: YES:
V. Do you require the Fire Alarm isolated: YES:
Name of Contact: . Do you require the Electricity isolated: YES:
Phone - Day time: Out-of-hours: Do you require IT Equipment isolated: YES:
Details of Personnel Accessing the Plant Do you need to access the Floor void: YES:
Please add extra paper if the space is insufficient Do you need to access the Ceiling void: YES:
Will the work disrupt Communications: YES:
Persons in charge:
Will the work disrupt IT Systems YES:
Phone - Day time: Out-of-hours Will the work disrupt Air Conditioning: YES:
List names of all other personnel: Will the work disrupt Electricity supplies: YES:
Will the work disrupt Water supplies: YES:
Will the work disrupt the Lifts: YES:
Will the work cause Dust: YES:
Will the work cause Steam: YES:
Will the work cause Noise: YES:
Will you carry heavy, unwieldy or otherwise
YES:
dangerous items within the premises:
Description of work: Will the work cause other effects: YES:
Will the work involve the use of substances
YES:
(gases, solutions, solvents, chemicals etc.)?
VI. Will you penetrate Structural Wall / Decking: YES:
Will you penetrate Partition or Fire Break: YES:
Will de-installation cause breaches to occur: YES:
Will installation cause breaches to occur: YES:
Will the work produce Flames, Fumes, Smoke: YES:
Plant Head DGM Engineer HSE Officer

Note: To be signed by whomever applicable at the then respective stage of the plant