Date : 8/18/2023

WORK PERMIT Page 1 of 2

Work Permit# : WP-0094-2023-08-3244 Date Filed: 8/16/2023 4:11:53PM

* Accomplish this from in four copies: (1) FMS/AEPM (2) CRO (3) Department/ Tenant (4) Requesting Contractor *

Department : WATSONS STORE CONSIGNOR AREA/LOCATION : SM PAMPANGA

Date (s): Aug 19 to Oct 15, 2023 Time (from): 10:00 am Time (to): 4:00 pm

Name of Contractor/Company: Fashion 21

Project Engineer/Supervisor: Winnie Genosas Emergency Contact No.:09088934735

Contact No. 09088934735

NAME OF PERSONNEL:
1 WINNIE BRIONES GENOSAS
2 Mary Rose Ignacio Parungao
Note: Above personnel should be properly identified and should always work within the visible distance of Security on
duty.

SCOPE OF WORK:
¨ Carpentry ¨ Painting ¨ Fixture
¨ Preventive Maintenance ¨ Electrical ¨ Plumbing
¨ Re-Tiling ¨ Installation ¨ Masonry
¨ AHU PM/ Aircon ¨ Sprinkler ¨ Ingress/Egress
¨ Delivery ¨ Pull-IN/ Pull-OUT ¨ Draining and Refilling
¨ Repair ¨ Physical Count ¨ Pest Control
þ Coordinator Store Visit ¨ Store ¨ POS Maintenance
Cleaning/Sanitation
¨ Escalator ¨ Elevator ¨ FDAS
þ Inventory ¨ Inspection /
Troubleshooting
Remarks: pick up documents , DTR & coordinate w/ beauty consultant/ check display and stocks

Note: For hot works activity, please fill up a separate Hot Work Permit and request for a Fire Safety Clearance from the
Bureau of Fire and Protection (BFP)

Personal Protective Equipment: (Contractor to determine applicable PPE based on scope)

¨ SCBA ¨ Gloves ¨ Harness
¨ Goggles ¨ Hard Hat ¨ Gas mask
þ Facemask ¨ Dust Mask ¨ Faceshield
¨ Welding PPE ¨ Safety Shoes ¨ Safety Harness
¨ Earplug/ Earmuffs ¨ Long sleeve shirts ¨ Overalls and Protective
Aprons
Remarks: eye glasses w/ grade

REQUEST FOR PERSONNEL POSTING: Note: To be filled up by Facilities Manager

¨ Security Guard ¨ Housekeeping ¨ Engineering
Other Requests:

Amount to be charged: 0.00

MATERIALS

SINumber List of Items/Equipment/Materials/Tools Quantity

5 Tape Measure 1
1 Ballpen 1
3 Belt 1
2 Cellphone Company 1
4 Documents 1
I hereby certify that all works to be done within the duration of this permit will be in accordance with the HOUSE RULES
& REGULATIONS/CONSTRUCTION GUIDELINES set by SM. I have understood all provisions and rules in the
pre-work SAFETY ORIENTATION as conducted by the Facilities Management.

REQUESTING DEPARTMENT/TENANT: CONTRACTOR REPRESENTATIVE/PROJECT ENGINEER:

Jelaisa D. Canlas Winnie Genosas

PRINTED NAME & SIGNATURE PRINTED NAME & SIGNATURE

Approved by:

Ryan M. Salazar LCG

Facilities Manager/Resident Engineer/Design Officer Approving Manager

Received by:

CRS ON DUTY

"This is an electronically approved generated work permit, no signature required"