Permit to Work

At Confined Space
 Page: 2 of 4
DATA CENTRE OPERATIONS
DCOS 1.1

Document information

Document name: 1.1 Permit to Work – at Confined Space

Version: 1

Created by: MMR

Approved by:

Classification: Internal

Date of version: 17/6/2024

Signature:

Next review date: 17/6/2025

Document references

Document name Version

DCOS – Data Center Operations Standard 2021

Revision history

Date Version Created by Description of change

17/6/2024 1.0 MMR First draft

PERMIT TO WORK – Confined Space

Document name: 766575470.docx

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DATA CENTRE OPERATIONS
DCOS 1.1

PART I: AUTHORISATION OF Confined SpaceSpace(To be completed by designated person)

This document provides the named Contractor with permission to undertake supervised to work
in confined space. All Confined Space must be vented for a period not less than 8 hours. All
Confined Spaces must be provided with auxiliary ventilation. A two-man rule is in force for all
work of this type. An ‘A’-frame man lift is to be available. The area is to be provided with
adequate barriers to prevent access.
Exact location of work: ……………………………………………………………………………………………………….

Details of work to be carried out/equipment: ………………………………………………………………….

Permit valid from (date/time): ………………………….. Until (date/time): ………………………..

--Special instruction and safety measures:

……………………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………….

SAFETY PRECAUTIONS
⃝ Is the fire alarm system isolated ⃝ Are all informed on the works
⃝ Is all equipment in safe working order ⃝ Is the fire suppression system isolated
⃝ Floor and area clean of combustibles ⃝ Has the sprinkler system been isolated
⃝ Combustibles move or covered (fire blanket) ⃝ Are fire detectors protected
⃝ Walls and door openings covered (fire blanket) ⃝ Is ventilation equipment provided
⃝ Is fire watch second man required ⃝ Are portable fire extinguishers present
⃝ Has smoking / naked light prohibited ⃝ Is a pressurised water hose present
⃝ Has fire watch been appropriately trained ⃝ Can the fire alarm be raised

I hereby declare that the above safety precautions and instructions have been made known to
the person in charge and the work area is safe for hot work operations to commence.

CONTRACTOR Syed Haseeb Raza GO REPRESENTATIVE Mr.Ibrahim

(name in print) (name in print)
SIGNATURE SIGNATURE

TIME AND DATE TIME AND DATE

CONTACT NUMBER 0549114159 CONTACT NUMBER 0551846335

EMPLOYED BY MMR & GO

(company name)

Document name: 766575470.docx

 Page: 4 of 4
DATA CENTRE OPERATIONS
DCOS 1.1

PART II RECEIPT AND DECLARATION (To be completed by person in charge)

I acknowledge receipt of this permit and understand the safety precautions and comments
described in PART I. Neither I, nor the personnel under my control will work on any other
activity or location other than those specified in PART I.

CONTRACTOR Syed Haseeb Raza GO REPRESENTATIVE Mr.Ibrahim

(name in print) (name in print)
SIGNATURE SIGNATURE

TIME AND DATE TIME AND DATE

CONTACT NUMBER 0549114159 CONTACT NUMBER 0551846335

PART III CLEARANCE (To be completed by the person in charge after work completion)

GO REPRESENTATIVE Mr.Ibrahim
(name in print)
SIGNATURE TIME AND DATE

CONTRACTOR
(name in print)
SIGNATURE TIME AND DATE

Document name: 766575470.docx