CONTRACTOR ACCESS REQUEST FORM

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CONTRACTOR ACCESS REQUEST FORM REVISION 6 SEPTEMBER 2015

CONTRACTOR ACCESS REQUEST FORM

Email completed form to security@toprydecity.com.au

Tenancy / Location of Works Trading Name

Principle Contractor Office

Contact Person Mobile

Date Commencing Expected Completion

D t Description of works to be

completed

YOU MUST INFORM SECURITY IF THE FOLLOWING ARE REQUIRED

WILL A FIRE SYSTEM IMPAIRMENT NOTICE BE REQUIRED? Yes No To be completed where sprinkler provision or smoke detection is isolated for any period of time.

WILL SMOKE DETECTORS NEED TO BE ISOLATED? Yes No If YES, for what duration? ___________________________________________

WILL A HOT WORKS PERMIT BE REQUIRED? Yes No Permit to be completed at Security should works generate a heat source.

IS LIGHTING REQUIRED IN A PARTICULAR AREA? Yes No If so, please indicate where___________________________________________

IS ROOF ACCESS REQUIRED? Yes No If so please complete roof access permit at Security.

MANDATORY REQUIREMENTS

All Contractors must be site inducted and have a current OHS white card

Copy of current Public Liability insurance for $20M and Workers Compensation Insurance provided

Safe Work Method Statements are to be provided and safe work procedures maintained at all times

Retailer adoption of liability letter provided

Confirmation from Retailer if works to be completed within tenancy.

The information that has been supplied to me by the sub-contracting company as I am, and have accepted the legal

responsibility as the tenancy’s authorised lessee and the designated controller of Centre under the NSW Occupational Health and Safety Regulations 2001, Division 1, clause 34 to 38.

TENANCY

REPRESENTATIVE Name Date Signature Phone

CONTRACTOR

REPRESENTATIVE Name Date Signature Phone

CENTRE MANAGEMENT

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CONTRACTOR ACCESS REQUEST FORM REVISION 6 SEPTEMBER 2015

Associated Staff Involved In This Project

Please nominate all staff that will complete any associated work at Top Ryde City throughout this project. In the event that additional staff are required, the Principal Contractor’s representative is to attend the Security

Office and include these persons on the associated client Contractor access request form.

No Company Name Employee Contact No: White No: Trade License

Type & No:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

ACKNOWLEDGEMENT OF INDUCTION

DATE

COMPANY NAME

NAME

SIGNATURE

INDUCTION No

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I

Contractor Security Form V1 Page 1

Top Ryde City Shopping Centre

BY SIGNING THIS SHEET YOU AGREE TO THE HOUSE RULES AS PROVIDED. DATE:

Time In Induction

Pass No.

Contact No's. (incl. Mobile)

Signature Area / Nature of Work Centre Induction carried out Sign In Completed (Staff Initials) Keys Issued Induction Pass Issued Time Out Signature Keys Returned

Cooling Tower Areas



Hot Works Permit



Roof Areas



Cooling Tower Areas



Hot Works Permit



Roof Areas



Cooling Tower Areas



Hot Works Permit



Roof Areas



Cooling Tower Areas



Hot Works Permit



Roof Areas



Time In Name Company Induction

Pass No.

Contact No's. (incl. Mobile)

Signature Area / Nature of Work Centre Induction carried out Sign In Completed (Staff Initials) Keys Issued Induction Pass Issued Time Out Signature Keys Returned                                                          Employee Name:   

Contact Details should notification be required.

Company: Employee Name: Company Address: _ _     Company:   Employee Name: Company Address:     G E NE RAL ACCE S S Employee Name: Company Address: C OM P L E T E T H IS S E C T ION IF A C C E S S IN G C OOL IN G T O W E R / RO O F O R CO NDUCT ING HO T W O RKS Company: Company: Company Address:

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Compliance Checklist Revision 6 September2015 Page 1 of 1

CONTRACTOR WHS&E COMPLIANCE CHECKLIST

Induction Number: _____ Principle Contractor Name: ______________________________ Date: __/__/__

Name: ________________________________________________

A member of the OHS team shall review the safety information/SWMS provided by the contractors/sub-contractors to determine if the following requirements have been adequately addressed, as applicable:

Item

No. Requirements

Details accepted Yes, No or N/A Principal

Contractor Sub-Contractor 1 A suitable Site-specific Safety Management Plan & signed Compliance deed provided. N/A 2 The SWMS contains the company name, is dated and signed by the person who

developed the SWMS.

3 Scope of work is appropriately detailed.( minimum 5 complete sentences )

4 Work site supervisor is identified – including name, title and contact phone number. 5 Construction/installation (step by step) requirements are detailed.

6 _{Risks related to tasks to be performed on-site have been identified and scores (1, 2 or} 3) have been applied to all risks.

7 Suitable control measures have been established for all risks identified.

8 For any Contractor, specifically Electrical or Plumbing contractors a current contractor’s licence( photo copy ) must be supplied with their subbie pack

9 All Principal and Electrical contractors are to state in their subbie packs that there is to be no working on live electrical systems or appliances except under the site specific electrical permit issued by the shop’s principal contractor

10 Persons responsible for implementing, monitoring and controlling hazards and risks are identified .name, title, phone number

11 _{There is reference to relevant sections of the NSW Workcover, OHS Regulations,} Australian Standards, Guides and NSW Workcover Codes of Practice (as appropriate). 12 Required workforce qualifications or work history for the type of work that they will be

doing on site (certificates etc) are to be listed.

13 Additional training needs are identified (if not applicable, please specify). 14 PPE requirements (mandatory & others) are identified.

15 _{Hazardous substances/dangerous goods to be brought on-site are identified (general} list). Supporting MSDS are provided ( not more than 5 years old )

16 Plant, equipment and hand tools required is listed including inspection, testing, servicing and maintenance details and intervals, as applicable.

17 The responsible Contractor/Sub-contractor has signed the SWMS.

18 _{Current Public Liability and Workers Compensation certificates are provided and are} current. And the previous two (2) months proof of payments for superannuation. 19 Other critical details provided (if appropriate) – please specify:

Notes: Where a sub-contractor has subcontracted a portion of their scope of works to others, a separate SWMS covering the sub-subcontracted work is required from the 2nd_{tier of sub-contractors.}

If the SWMS is rejected centre management, the contractor/sub-contractor will be contacted by for further information and action.

RESULTS OF REVIEW: The SWMS is ACCEPTED  REJECTED 

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IMPAIRMENT NOTIFICATION FORM Revision 6 September 2015

IMPAIRMENT NOTIFICATION FORM

To: AIG Impairment Notification Fax: 02 9240 1722

Email: impairment@aig.com

troy.bates@aon.com dave@toprydecity.com.au

Security@toprydecity.com.au

security-mgr@toprydecity.com.au

From: Top Ryde City

Address: 109-129 Blaxland Rd, Ryde, 2112

Date: …….……….. Isolated by: ……… Re: FIRE PROTECTION SYSTEM IMPAIRMENT NOTICE

Company requesting isolation: ……… Person ……… Phone No: ...

Commencement time/date: ...

1. System to be Shutdown (Please Tick)

[ ] Automatic Sprinklers [ ] Fire Pump(s) [ ] Fire Alarm System [ ] Fire Main

[ ] Firewater Tank [ ] Smoke Detectors

Reason for shutdown: ... ………

Isolation Asset no: ...

Area Isolated: ...

Precautions to be followed: (Please Tick)

[ ] Use Shut off tag [ ] Notify area supervisor [ ] Cease hazardous operations [ ] Hose/extinguishers available [ ] Ban welding/cutting/hot work [ ] No smoking

[ ] Notify Fire Department [ ] Notify alarm company

[ ] Work to be continuous [ ] Additional watchman surveillance [ ] Emergency connection planned [ ] Emailed to insurance

2. Security

AIG Notified of Isolation ___:___hrs on ___/___/___

Security Guard: ………Signature ...

3. Advised when fire systems are fully restored.

Company requesting de-isolation: ……… Person ……… Phone No ……… Signature ……… Date:……….. Time:……….. 4. Security final sign off

Security Guard: ………Signature:……….

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THINK SMART

Confined Space Entry Permit Revision 6 August 2015

Page 1 of 1

CONFINED SPACE ENTRY PERMIT

Company Name: Store Name & N

o

This Permit is to be prepared by the Tenancy Principle Contractor’s Supervisor/Foreman prior to anyone being authorised to enter an area identified as a Confined Space Work Area.

Permit Application

Organisation Requesting the Permit:

Person Requesting the Permit: Date: __/__/__ Time: am/pm Description/Location of Work Area:

Isolation

Electrical Isolation Required: Yes/No If Yes, Verify Isolation established:__________________________ Signature

Mechanical Isolation required: Yes/No If Yes, Verify Isolation established: __________________________ Signature

Ventilation

Circle the type of Ventilation that must be used: Natural Forced

Hot Work

Is Hot Work being performed in the Confined Space? Yes/No,

If Yes, A Hot Work Permit is Required. Hot Work Permit N

o

_:

PPE, Plant and Equipment

Identify the PPE, Plant and Equipment that must be available inside the Confined Space Area: (tick)

Overalls Respirator Harness Fire Extinguisher

Gloves Breathing Apparatus Safety Line Gas Detector

Eye Protection Self Rescue Respirator Fall Arrest Device Lighting

Welding Helmet Chemical Suit Hoist/Winch Barricades Warning Signs

Hearing Protection Helmet First Aid Kit 2-way Radio’s

Fire Blanket Air Ventilation Fans Waste Bins Scaffold &/or Ladder Emergency Standby Personnel

Is a Standby & Rescue Person Required? Yes/No If Yes Name the Person assigned: Are they a Qualified First Aider? Yes/No

Are they inducted into the site’s Confined Space procedure? Yes/No Training

All personnel are inducted into the Site’s Safety Procedure for working in Confined Space: Y/N

Emergency Evacuation Procedure is in place & everyone is inducted/trained in its requirements: Y/N

Atmospheric Testing

Complete Peak Readings Prior to entry: Date of Gas Monitor Calibration. __/__/__ Explosive Gas___% (must be below 5%). LEL Hydrogen Sulphide...ppm (must be below 10ppm). Oxygen...% (must be between 19.5 & 23.5%). Carbon Monoxide...ppm (must be below 35ppm). Continuous monitoring required during occupancy. Yes/No

Gas testing By: NAME... SIGNATURE... Authority to Enter

Work inside this Confined Space Area is authorised based on the precautions listed above. Name:...Signature:...Date: __/__/__ Time: am/pm. Job Completion

All Persons have left the Confined Space Area. No Further entry is permitted without a new Permit. Name:...Signature:...Date: __/__/__ Time: am/pm. Comments:

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THINK SMART

Hot Works Permit Revision 6 September 2015 Page 1 of 2

Hot Works Permit

PROJECT NAME DATE

Company Hot Work Permit no.

Work Location ( attach map/sketch )

Details of the Scope of work covered by this permit

Equipment to be used in this scope of work.

A List of the Fire Fighting Equipment to be placed within two (2) metres of the work site.

Supervisor Directly Responsible for the scope of the Hot Work under this permit only.

Name: Signature: Name of the work crew working to this hot work permit and signature

Name______________________________________________________________________________ ( print ) ( sign ) Name ______________________________________________________________________________ ( print ) ( sign ) Name_______________________________________________________________________________ ( print ) ( sign ) Item No.

Hot work permit conditions to be verified before any work takes place under this permit. YES / NO N/A

1 Have all combustible materials been removed from the work area or made safe?? 2 Is ventilation adequate?

3 Is lighting adequate?

4 Are spark arrestors fitted to the oxygen / Acetylene set and in good working order? 5 Are flash screens fitted and set up for any arc welding that is to take place.

6 Has the fire fighting equipment been checked / tagged and ready for use 7 Is a fire watchman required

8 If yes, is the fire watchman trained in this scope of work.

9 If the scope of work is being carried outside are the weather and wind conditions suitable for the hot work required

10 Are the hot works being carried out in a potentially confined space area? If YES, a confined space entry permit must also be issued and filled out correctly.

11 Is a fire ban of any description in place

12 If yes, has a permit been received from the authorities?

13 At the completion of the work, the area is to be checked to make sure that there is no smouldering material left over from the scope of work just finished.

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Hot Works Permit Revision 6 September 2015 Page 2 of 2

Permit Conditions:

• This Permit is only valid for one full shift or less if specified below. Where more than one shift is

involved, the permit must be renewed by the following shift.

• All details stated above must be implemented by the supervisor responsible for how work activity

is to be carried out.

• Hot work permit to be displayed in a prominent location while works are in progress.

• The Tenancy Principle Contractor has the right to withdraw the permit at any time.

• Responsible supervisor is obligated to stop hot work activities if any of the above permit

conditions (including items 1-9) are not being met.

• Additional conditions:

Permit Conditions Accepted: ___________________________________________________

Hot Work Responsible Supervisor’s Signature/date

Permit Issued by: ____________________________________________________________ Tenancy

Principle Contractor Supervisor’s Name Signature Date

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THINK SMART

Live Electrical Works Permit Revision 6 September 2015 Page 1 of 4

Live Electrical Works Permit

The scope of work stated in this permit will be carried out under following regulations, chapter 7, part 7.7, Live Electrical Work, clause 207

N.S.W. O.H.S. Regulations 2001

Section 1 Shop Number and Name:_______________________________________________ Date: //

Principal Contracting Company’s Name:_____________________________________

Principal Contracting Company’s Representative: _______________________________________________________

( print name) ( signature )

Section 2 Shop’s Electrical Contracting Company’s Name:________________________________________________________

Electrical Contracting Company’s Representative:______________________________________________________

(Print Name) (Signature)

Name(s) of the Qualified Person(s) and position(s) of who will be working under this permit?

PRINT NAME

SIGN NAME

TRADE / JOB POSITION

TRADE LICENCE NUMBER

Section 3

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Section 4 Special Precautions Required Prior to any systems / Equipment Being Energised:

_______________________________________

_________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________

Section 5 Equipment to be Energised:_Location:

Reason:___________________________________________________________________________________________

_____________________________________________________________________________________

Section 6 DECLARATION:

We hereby make a request for the above System(s) / Equipment to be energised. We confirm that all special

precautions noted above have been carried out and that all works associated with the above mention scope of works

on this permit complies in all respects to the relevant Codes and Statutory Requirements and specifications.

______________________ _ //

(electrical sub-contractor print and sign ) ( position ) ( date )

Section 7 Approved by the Shop’s Principal Contractor:

____________________ //

( principal contractor print and sign your name ) (position ) ( date )

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From the OHS Regulations 2001. Chapter 7, Part 7.7 clause 207 Electrical work on electrical installations – Safety Measures.

(1) Employer must ensure that any electrical work on a electrical installations at a place of work is carried out using a safe system of work.

(2) An employer must ensure that such work is not carried out while the circuits and apparatus of the part of the installation that is being

worked on are energised.

(3) The safe system must include.

(a) Checks to ensure that the circuits and the apparatus of the part of the installation that is being worked on are not energised before work

commences and remain that way until the work is complete, and

(b) Measures to eliminate or control the risk of the person carrying out the work inadvertently contacting any part of the installation that

remains energised.

(4) Despite subclause (2), electrical work on electrical installation may be carried out while the circuits and apparatus of the part of the

installation that is being worked on are energised if it is necessary to do so in the interests of safety and the risk of harm would be greater if

the circuits and apparatus were de-energised before work commenced. In these circumstances the employer must ensure that:

(a) Before the work is commenced, a written risk assessment has been completed in respect of the work in consultation with the persons

proposing to do the work, and

(b) the work is carried out in accordance with the safe work method statement for the work, and

(c) the work has been authorised by the person in control of the premises, and

(d) the persons doing the work are appropriately qualified, trained and instructed in the safe work practices, for the particular task, including

the proper use of test equipment, tools, accessories and personal protective equipment, and

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( e ) appropriate test equipment and tools and accessories are provided to the persons doing the work, are properly used and are well

maintained, and

( f ) appropriate clothing and personal protective equipment for the work are provided to the persons doing the work and are properly worn

and used, and

( g ) the isolation point of the relevant electrical supply has been clearly indentified and is able to be reached and operated quickly without any

need to negotiate or remove obstacles, and

( h ) the work area is clear of obstructions so as to enable entry and exit quickly and safely, and

( i ) unauthorised persons are prevented from entering the work area by signage or barriers, and

( j ) the work is undertaken in the presence of a safety observer who is competent to perform the particular task that is to be carried out and is

competent in electrical rescue and cardio-pulmonary resuscitation, and

( k ) in the case of electrical work at a mining workplace or coal workplace, notice is given of the proposed work, at least 7 days before the

work commences, to a inspector appointed in relation to the mining workplace or coal workplace.

( 5 ) This clause does not apply to electrical work carried out under a plan require to be lodges under the

Electricity Supply ( Safety and

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Revision 6 September 2015 Page 1 of 2

ROOF ACCESS PERMIT

PART A – Contractor to Complete

1. Contact Details

Site Order Number

(If applicable)

TRC Contact Name Phone / Mobile

Position Email / Fax

2. Contractor Details

Type Contractor [ ] Tenant Contractor [ ] Other: ………

Company Name Site Contact

(Name & Position)

Address Contact Details

(include mobile)

Name of Contractors involved in works Induction No’s(Induction No’s not reqd. for Tenant or One Off Contractors)

3. Scheduled Works

Date of Works: Start Time: End Time:

Work Area: Description of Work:

If the works are to exceed stated end time you are to inform Centre Management. 4. Attachments

1. Please attach a copy of your risk assessment for the above works.

Note: Not required for TRC contractors if you’ve already provided RA’s for this task.

2. If you are a tenant instructed contractor or this is a one-off job you are also required to attach a copy of relevant insurances, licenses and training records.

Yes [ ] No [ ] Yes [ ] No [ ] Risk Assessment Requirements / Considerations

 Operatives have appropriate height safety training, Licence specified work task.

 Safety induction training

 Works are not to be conducted 2meters or near any unprotected edges

 Fragile roof areas are adequately identified and controlled

 Objects falling from roof areas

 Barricades and signage is in place during roof works.

 No telecommunications equipment located nearby.

 Personnel Protective Equipment (harness, lanyard, etc.) provided

5. Declaration

Signed: ……….. Name: ……….. Once completed forward a copy, along with attachments, to TRC Security prior to attending site.

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Revision 6 September Page 2 of 2

PART B – TRC SECURITY to Complete

1. Notification

The Contractor has provided copies of their risk assessments and any other relevant

documentation as detailed in part A of this form. Yes [ ] No [ ] The attached documentation has been reviewed and deemed satisfactory.

Note: If not satisfactory, the contractor will be required to resubmit the necessary documentation.

Yes [ ] No [ ]

2. Authorisation

The works detailed in Part A of this form are permitted to proceed in accordance with submitted risk assessments.

Name Job Title

Signature Date

Return this form to the Contractor detailed in Part A.

PART C – Contractor to Complete

The authorisation has been given for you to commence work, i.e. the above has been signed by TRC Centre Management.

If no, contact TRC Centre Management and seek approval.

Yes [ ] No [ ]

WORKS CAN NOW COMMENCE

PART D – Contractor to Complete

1. Post Works

The works detailed in Part A have been completed in accordance with the submitted risk

assessments. Yes [ ] No [ ]

Access restrictions have been reinstated upon works completion Yes [ ] No [ ] Any new/outstanding issues are flagged with TRC Centre Management Yes [ ] No [ ]

2. Declaration.

Signed: ………. Time: ……….. Date: ………..

See centre Security immediately upon completion of works.

PART E – TRC SECURITY to Complete

1. Final Sign off

The contractor has returned this form to you upon completion of the works Yes [ ] No [ ] The contractor notified you of the time that they left the site Yes [ ] No [ ] All works were completed in accordance with initial instruction. Yes [ ] No [ ]

CONTRACTOR ACCESS REQUEST FORM

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