WORK PERMIT APPLICATION

FORM
SECTION A. APPLICANT INFORMATION AND GENERAL DETAILS (TO BE ACCOMPLISHED IN FULL)
Fit Out Mobilization Tenant Contracted Maintenance Works PERMIT NUMBER
General Fit Out Work General Access/ Visit / Inspection (For Official Use only)

Demolition Permit Stock taking / Merchandising

PERMIT TYPE:
Excavation Permit Event Set up/ Activation/Demobilization
FM Services Permit Artwork/Signage Installation/Removal
Hot Work Permit Hoarding Installation/Removal
BUSINESS UNIT / LOCATION YAS MARINA DRY STACK THE FOUNTAINS WEST YAS PLAZA YAS BAY YAS ARCADE
COMPANY / CONTRACTOR NO. OF WORKERS ON SITE
UNIT # / KIOSK # OUTLET NAME / TRADE NAME
START DATE & TIME END DATE & TIME:
WORK LIMITED TO THE FOLLOWING
Brief description of the job:

SECTION B. UNDERTAKING AND CONFIRMATION

I have ensured that the controls described here have been implemented and it is safe to commence work.
I confirm that I read and understood Section E of the work permit application.
I have instructed all persons under my control in the hazards/risks and control measures.
I confirm that all the provided information is reviewed before submitting to Cascade Dining management and all information are true.
I shall not alter/modify any Landlord provisions/base built unless approved by the management.
I acknowledge the risks and hazards involved in every task, thus responsible and fully liable in case of accident (damage to property, injury etc.)
Vaccinated : Adherence to current Authority Covid-19 requirements.
Without Vaccine : Adherence to current Authority Covid-19 requirements.

SIGN &
SITE IN-CHARGE PHONE# DATE:
STAMP
SECTION C. AUTHORIZATION TO COMMENCE WORK
APPROVED BY FM SIGN DATE:

APPROVED BY HSE SIGN DATE:

SECTION D. REMARKS

SECTION E. APPLICATION GUIDELINES AND CONDITIONS

a. This Permit has been issued on the request of the Applicant and does not relieve the tenant or the Contractor appointed by them from any legal and/or
contractual obligations.
b. In addition to this access permit, necessary HSE Permit to be secured for specific tasks such as Confined Space Entry, Work at Height, Hot Work, Spray Painting,
Film Shooting, Excavation Works, Handling of Chemicals.
c. In addition to this access permit, necessary Isolation Permit to be secured for Fire Alarm System, Fire Fighting System, BMS, Chilled Water, Power, Emergency
Lights, Gas Supply, Water, Drainage, CCTV, Common Area Lighting.
d. 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 Engineer or Building Security.
e. Site Security will deny access for any person without “Al Hosn Green Pass”.
f. 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.
g. Any noisy or malodourous activities such as drilling, coring, painting, 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.
h. Any works on existing building services and systems such as MDB/SMDB modifications/terminations, Fire Alarm & Fire Fighting, Emergency Lighting, BMS,
HVAC Controls, CCTV, Access Control System, Motion Sensors, Power & Lighting in common areas etc. must be carried out through the FM Service Provider
only.
i. Applicant shall take adequate control measures and provide qualified fire watch(es) for monitoring the affected areas in the event of a Fire Detection and/or
protection system impairment. Fire watch(es) shall be in place till the impaired systems are re-instated to the satisfaction of Facilities Manager / FM service
provider.
SECTION F. PERMIT CLOSURE / CANCELLATION
Cancellation: This permit is herewith cancelled and the work stopped for the following reason/s: Date:_____________________
A dangerous situation developed that impact on safety. An emergency / incident occurred
Serious breach of the conditions of the PTW. The scope of the work has changed
Closure: I accept that the work specified above in this permit has been completed. Date:______________________
All locks and tags are removed. Work place is cleaned and secured. Equipment is ready for operation.

FM Approval HSE Approval

YM/CD/FM/FOR/OO1/V4.0 YAS ASSET MANAGEMENT LLC 2021