WORK PERMIT

DATE FILED: _________________________

TO : SM ADMINISTRATION OFFICE
FROM :
INSTRUCTION: Please check the box that applies and fill out all the details. Please attach all required documents for this
work permit to be processed (refer to Circular to Tenants on Work Permit Guidelines).

 Construction  Renovation  Operations

SCOPE OF WORKS
 Maintenance  Repair  Installation  Waterproofing  Welding/Hot Works
 Carpentry  Exhaust/Fresh Air  Electrical  Plumbing  Spray Painting
 Masonry  Aircon  Gas Line  Draining and Refilling  Sanding
 Specific
 Remarks
Note: For welding or hot works, please answer the Hot Works Permit Checklist on the back page.

 Ingress  Egress  Delivery  Pull-out

 Particulars
 Remarks
Others

VALIDITY From To NAME OF CONTRACTOR:

Date NAMES OF PERSONNEL:
Time 1. 5.
2. 6.
LOCATION 3. 7.
4. 8.

REQUESTED BY: TENANT’S OR CONTRACTOR’S AUTHORIZED SIGNATORY

Signature over printed name and designation

CONCURRED BY: APPROVED BY:

CRS EDD MALL OPERATIONS

FOR MALL ADMINISTRATION:

Request for access to: From: To:

REQUEST FOR PERSONNEL POSTING:

 Guard:  Janitor:  EDD:
From: From: From:
To: To: To:

Other requests:
FOR TENANT/CONTRACTOR:
HOT WORK PERMIT CHECKLIST
Any operation or work requiring the use of any equipment, apparatus, or other means utilizing open flames, heat, or which
is spark-producing is defined as “HOT WORK”.
INSTRUCTION: Check each item if complied or validated.
# YES NO N/A CHECKLIST REMARKS
REMINDERS
1 Appropriate fire extinguishers are provided in the working area.
People carrying out hot work are informed of:
a.) What to do if they discover a fire;
2
b.) How to raise the alarm;
c.) Evacuation procedure and assembly point.
3 Smoke or fire detectors are reconnected immediately after work is completed.
4 Smoke or fire detectors are uncovered immediately after work is completed.
SAFETY PRECAUTIONS
5 Available sprinklers, hose streams, and extinguishers are in service and operable.
Hot work equipment is in good working condition in accordance with the
6
manufacturer's specifications.
Special permission is obtained to conduct hot work on metal vessels or piping
7
lined with rubber or plastic.
REQUIREMENTS
8 Flammable liquid, dust, lint, and oily deposits are removed.
9 Explosive atmosphere in area is eliminated.
10 Floors are clean and trash is removed.
Combustible floors are wet down, covered with damp sand or fire resistive/con-
11
combustible materials or equivalent.
12 Personnel is protected from electrical shock.
Other combustible storage material is removed or covered with listed or
13 approved materials (welding pads, blankets, or curtains; fire resistive tarpaulins),
metal shields, or noncombustible material.
14 Combustible material on either side of walls, ceilings, or roofs is moved away.
15 All wall and floor openings are covered.
Ducts and conveyors that might carry sparks to distant combustible material are
16
covered, protected, or shut down.
17 Construction is combustible and without combustible coverings or insulation.
18 Enclosed equipment is cleaned of all combustibles.
19 Containers are purged of flammable liquid or vapor.
Pressurized vessels, piping, and equipment are removed from service, isolated,
20
and vented.
A firewatcher, whose sole duty is to be on the lookout for fire hazards and to
21 operate firefighting equipment, is assigned on each location where hot work is
being performed.
Fire watch is provided during and for a minimum of 60 minutes after hot work,
22
including break activity.
Fire watch is provided with suitable extinguishers and, where practical, a charged
23
small hose.
24 Fire watch is trained in the use of equipment and in sounding alarm.
25 Fire watch is present in adjoining areas, above, and below.
Hot work area is monitored for up to an additional three (3) hours after the 60-
26
minute fire watch.
Electrical equipment to be worked on is de-energized, switch locked in the open
27
position, and provided with the proper tags.
AFTER WORK VALIDATION:
This is to confirm that the area was checked and cleared 30 minutes after the hot work was completed; and fire protection
and detection systems were returned to normal settings/conditions.

# CHECKLIST NAME OF PERSONNEL REMARKS

28 Fire Pro was returned to normal setting by:
29 Smoke Detection was returned to normal by:

PREPARED BY: NOTED BY: APPROVED BY:

Contractor’s Safety Representative Resident Engineer Building Administration Officer