ALMI-OHS-F-006.x GWP Control No.
: ______________________
Permit validity: ________________________
GENERAL WORK PERMIT
I. General Information (to be filled up by requester)
Merchant Appyling for General Work Permit: ________________________________________________ Date Prepared:___________________
Company Name of Contractor: ___________________________________________ Emergency Contact Number: _____________________
Name of Contractor's PIC: ____________________________________ Name of Designated Safety Officer: __________________________
Work Description (specify): ________________________________________________ Date of Actual work: __________________________
Location(s) of Activity: ___________________________________________________________________________________________________
Specific Works to be done:
Other Permits to be secured for Critical Works (check all that apply) ___ N/A
___ Hot works ___ Electrical Works ___ LPG Works ___ Confined Space Entry ___ Lifting & Rigging ___ Work at Heights
II. Permit Application Compliance Checklist: (to be filled up by mall engineer)
Critical works permit as may be applicable
Copy of approved risk assessment and method statement specific for the work applied for signed by the designated safety officer
40-hr. BOSH or COSH certificate (SO2 level) of designated Safety Officer
Proof of attendance to the "2-hr. mall safety and security house rules orientation for contractors"
List of workers to execute activity
List of equipment and tools to be used for the activity
III. Method statement compliance inspection checklist: (to be filled up by mall engineer)
IV. Safety Inspection Checklist: (to be filled up by mall safety during inspection)
Presence of designated Safety Officer on-site
Availability of copy of approved risk assessment and method statement
Availability of copy of BOSH or COSH training certificate of contractor's/merchant's designated Safety Officer
Availability of copy of list of tools and equipment to be used for the activity
All hazards including information on the type of exposure, signs or symptoms and consequences are evaluated through the Risk
Assesment and are all addressed.
Work area was thoroughly inspected 30 mins. BEFORE work. (contractor shall be reminded to remain 30 mins. after)
Appropriate standard approved PPEs (based on approved RA & MS) are in-good condition and well-maintained
I hereby certify that all information and documents provided above are all correct and valid. All works to be done within the duration of this
permit shall be in accordance with the House Rules & Regulations / Construction Guidelines set by Ayala Malls.
We have understood all provisions and rules in the "Pre-work Safety and Security Orientation" as conducted by the Ayala Malls Administration.
We acknowledged and will subject to the consequences for any violations committed by our company representatives and workers.
Requested by: _________________________________ Noted by: _________________________________________
Printed Name & Signature of Contractor Printed Name & Signature of Project/Store Owner
Approved By: __________________________________ ________________________________
Ayala Malls Chief/Building Engineer Date Signed
Approved By: __________________________________ ________________________________
Ayala Malls Safety Officer/Coordinator Date Signed
Remarks:
V. Daily inspection/Monitoring (to be filled up by Mall Safety/Security)
Print Name and Signature
Mall Inspector: _______________________________________
Day 1: Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
Mall Inspector: _______________________________________
Day 2:
Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
Mall Inspector: _______________________________________
Day 3:
Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
Mall Inspector: _______________________________________
Day 4:
Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
Mall Inspector: _______________________________________
Day 5:
Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
Mall Inspector: _______________________________________
Day 6:
Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
Mall Inspector: _______________________________________
Day 7:
Merchant/Contractor Representative: _______________________________________
Findings/Remarks: _______________________________________
VI. Close-out inspection Checklist (to be filled up by Mall Safety)
Contractor did close coordination with the "Mall Safety Team" to conduct inspection prior to egress of workers.
Area is clean; Good housekeeping is observed in the workplace.
No signs of smoking activity: cigarette butts, ashes, packs and smell of cigarette smoke.
Workplace is secured.
Workers are reminded to log-out at the designated contractor's access point.
Requested by: _________________________________
Printed Name & Signature of
Inspected and Witnessed by: __________________________
Ayala Malls Chief/Building Engineer
IMPORTANT REMINDER:
In case of emergencies, contractor shall immediately call the mall's emergency hotline: 0917-568-9495
Rev.00
