MINISTRY OF INTERIOR

QATAR CIVIL DEFENSE

FIRE PREVENTION DEPARTMENT
Form SS-ITM-M/E-O-01

SUMMARY FORM - INSPECTION, TESTING & MAINTENANCE ( 1 OF 2 )

APPLICATION NO.: DATE: 17/07/2023

PROPERTY INFORMATION :
Building Name : WE TRADE FOR TRADING AND CONTRACTING QCD Building Completion Certificate No :

Bldg. No. / Street No. / Zone No. : LOGISTIC VILLAGE Office Contact Nos. :

Occupancy Classification : ORDINARY Building Height : Building Area :

Type of Construction : Hazard Classification : ORDINARY HAZARD

Fire Protection Systems (System Code / Designation) :

I – Automatic Sprinkler VIII – Fixed Wet Chemical Extinguishing System

✔ II – Fire pump IX – Clean Agent Fire Extinguishing System
III – Water Supply System X – Fixed Aerosol System
✔ IV – Standpipe and Hose System ✔ XI – Portable Fire Extinguisher
V – Fire hydrants ✔ XII – Fire Detection and Alarm Systems

VI – Water Mist System ✔ XIII – Emergency Lighting & EPSS

VII – Foam System XV – Others

FACILITY MANAGER :
Name / QID /Mobile No.: Signature :

CONTRACTOR’S INFORMATION :
5 FF Contractor Name : ADAM STAR TRADING & CONTRACTING W.L.L FA Contractor Name: ADAM STAR TRADING & CONTRACTING W.L.L

Company Address : BIN MAHMOUD-DOHA QATAR Company Address : BIN MAHMOUD-DOHA QATAR

Office Contact No. : 41400922 Office Contact No. : 41400922

Company Registration No. : 135969 Company Registration No. : 135969

Contractor’s Grade: Contractor’s Grade:

Grade A Grade B Grade C Grade D Grade A Grade B Grade C Grade D

Engineer’s Name / FF or FA QID Mobile No. Signature

SAJAN SUNNY 28935615646 50339467

SHAKEEL 29335615106 66851943

Contractor’s Stamp / Signature: Stamp / Signature:

ITM Contractor Facility Manager

 MINISTRY OF INTERIOR
QATAR CIVIL DEFENSE
FIRE PREVENTION DEPARTMENT
Form SS-ITM-M/E-O-01

SUMMARY FORM - INSPECTION, TESTING & MAINTENANCE ( 2 OF 2 )

Building Name: WE TRADE FOR TRADING & CONTRACTING Reference No. : Date:
- 17/07/2023

Owner :
WE TRADE FOR TRADING & CONTRACTING
Contractor :
ADAM STAR TRADING & CONTRACTING
Is the Building Occupied ? Y ✔ N Has Occupancy and Hazard remained the same? Y ✔
N

Are all fire protection systems in service ? Y ✔ N System has not been modified ? Y ✔ N

Was the system free from actuation of devices or alarms? Y ✔

N Explain any NO answer :

SIGNICANT NOTES / COMMENTS: ( explain any NO answer )

The Building is ready for QCDD inspection / assessment and has successfully completed all necessary
Inspection, Testing and Maintenance Works.

APPROVED REJECTED

Engineer’s Name / FF or FA QID Mobile No. Signature

SAJAN SUNNY 28935615646 50339467

ALI SANAH 29435610800 50452560

Contractor’s Stamp / Signature: Stamp / Signature:

ITM Contractor Facility Manager