Gilmore WP

ENGINEERING DEPARTMENT
WORK PERMIT FORM
DATE : ____________________
To : SECURITY & SURVEILLANCE DEPARTMENT
Please allow the following person(s) who is/are representing the Contractor/Vendor to enter the premises.
Company Name : _________________________________ Contact No. : _______________________

Authorized Representative Name : _________________________________ Position : _______________________
Area of Work to be allowed in : ______________________________________________________________________________
Work Description to be done : ______________________________________________________________________________
A risk assessment has been done Yes No
Name of Persons/Workers
Name Position Name Position
1. ______________________________ FLM
_________________________ 6. ______________________________
x _________________________
x
2. ______________________________ Tech
_________________________ x
7. ______________________________ _________________________
x
3. ______________________________ Tech
_________________________ 8. ______________________________
x _________________________
x
4. ______________________________ Tech
_________________________ x
9. ______________________________ _________________________
x
5. ______________________________ Tech
_________________________ x
10. ______________________________ x
_________________________
(Use additional sheet if more names to be included)

__________________________________________________________________________________________________________________
For the purpose of:
Hot works Carpentry Electrical Preventive Maintenance
Construction Excavation Delivery Others: ______________________________
(please specify)
__________________________________________________________________________________________________________________
Date covered from : _____________________________ To : _________________________________________________
Time covered from : _____________________________ To : _________________________________________________
Total no. of Days required : _____ days To : _________________________________________________
Requested by: Approved by: Approved by:

(Vendor/Contractor Authorized Representative (Duty Engineer/Manager/DOE) (Safety Manager/Officer)
GLEN B. OSERA
___________________________ Jean Paul Singson
___________________________ Daryl B. Dizon 1003048
___________________________
Date: Date: Oct. 27, 2023 Date: 10/27/2023 1655H
CONDITIONS:
1. This form must be accomplished by the contractor.
2. “HOT WORK PERMIT and FIRE PROTECTION IMPAIRMENT PERMIT” should be secured and attached if welding or any hot work is to be performed.
Work/s that is/are 2 meters high and above, a “WORKING AT HEIGHT PERMIT” should also be secured and attached same to this permit. To work in a confined
space a “CONFINED SPACE ENTRY PERMIT” must be secured too.
3. Employees/workers of the contractor/vendor should be aware of City Of Dreams (Melco Resort Leisure Philippines Corp.) house rules. A copy of which
is attached and to be acknowledged by the contractor/vendors’ representative. By signifying request of the form, the contractor/vendor is hereby automatically
acknowledged the City Of Dreams (Melco Resort Leisure Philippines Corp.) house rules & requirements.
4. This work permit must be posted on site during the working hours or always a photocopy in possession of the Contractor/Vendor’s authorized representative readily
for inspection at all times.
5. To be aware and follow the company’s policy on Environment & Safety.
6. Any violation made by the Contractor/Vendor’s employees or workers of the above will be grounds for revocation of this permit or COD Manila might just demand
the Contractor/Vendor to replace the workers/employees involved in the violation.
DATA PRIVACY CONSENT

I expressly agree, consent, and authorize Melco Resorts Leisure (PHP) Corporation to collect, process, use, retain, store, and treat automatically or
mechanically any personal, sensitive personal, or privileged information, as defined in the Data Privacy Act of 2012 (collectively, “Personal Data”) provided
I have or will provide, in connection with the recording of my official visit to the back of house areas of City of Dreams Manila.
I further authorize Melco Resorts Leisure (PHP) Corporation to share, transfer or disclose any or all of my Personal Data that I have disclosed, to any other
company or entity directly or indirectly under the control of, or owned by Melco Internal Development Limited, or to the Melco Resorts Leisure (PHP)
Corporation’s affiliates, service providers, agents or successors-in-interest, which may be located in a country other than my country of residence, and I
consent to such worldwide data processing, if the same is needed and/or required.
I understand that I may visit www.cod-manila.com for more information on how Melco Resort Leisure (PHP) Corporation’s processes my Personal Data and the
contact details of its data protection officer, and www.privacy.gov.ph for more information about my rights as a data subject.
Form No. COD-ENG-WP-14-004

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ENGINEERING DEPARTMENT

WORK PERMIT FORM

To : SECURITY & SURVEILLANCE DEPARTMENT

Company Name : ___________ Contact No. : _

A risk assessment has been done Yes No

(Use additional sheet if more names to be included)

Requested by: Approved by: Approved by:

Date: Date: Oct. 27, 2023 Date: 10/27/2023 1655H

DATA PRIVACY CONSENT

Form No. COD-ENG-WP-14-004

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