Work Permit Application

Permit Number(*)
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Location(*)
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Section 1 : Tenant Authorization

Tenant Name(*)
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Company(*)
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Person in Charge(*)
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Telephone No(*)
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Email Address(*)
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Section 2 : Main Contractor / Supplier

Company(*)
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Address(*)
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Site Supervisor(*)
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Telephone(*)
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Email(*)
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Permit Begins(*)
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Permit Expires(*)
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Section 3 : Work Classification

Work Classification(*)

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Insurance Coverage

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Section 5 : Hazards / Hazardous Activities

Hazards & Hazardous Activities

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Basic

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Eye, Face & Body Protection

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Respiratory Protection

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Hand Protection

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Hearing Protection

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Fall Protection

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Personal Monitoring Equipment

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Others

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Section 7 : Applicant Declaration
I/we have read the Tenancy Design and Fit Out Guideline and KOMTAR JBCC House Rules and fully understood on the rules and regulation and I/we shall abide to it accordingly. This work permit will be automatically cancelled if we violate any of the terms.

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(*)
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(*)
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Work Permit is approve from (*)
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Work Permit is approve to(*)
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Name(*)
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Designation(*)
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