BERYL ENGINEERING & PROPERTIES LTD.

Tel: 08133468405, 09050909431 | Email: berylengineeringpropertiesltd@gmail.com

Web: www.berylengineeringpropertiesltd.com.ng

Doc. No.:BEP-FRM-001

Version:1.0

Date Completed:

Reviewed On:(office use)

CONSTRUCTION SITE VISIT REQUEST & CLIENT ACKNOWLEDGEMENT FORM

CONFIDENTIAL — For use solely between Beryl Engineering & Properties Ltd. and the named client.

CLIENT INFORMATION

Client Name

Company

Contact Person

Phone

Address

PROJECT INFORMATION

Project Name

Project Address

Purpose of Visit

Project Description

CLIENT'S PROPOSED INSPECTION DATE

Preferred Date

Preferred Time

Alternative Date

Alternative Time

The proposed inspection date and time are subject to confirmation by Beryl Engineering & Properties Ltd. Final confirmation shall be communicated through telephone, email, WhatsApp or any mutually agreed communication channel.

SITE ACCESSIBILITY

Road Accessibility

Parking Availability

Access Restrictions

Site Contact Person

Phone Number

EMERGENCY CONTACT AT SITE

Primary Contact

Position

Phone Number

Alternative Contact

Alternative Phone

SITE SAFETY INFORMATION

Known Security Concerns

Known Site Hazards

Nearest Landmark

Availability of Security Personnel

Any Ongoing Security Issues

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Will PPE be required?

Yes No

If Yes, tick applicable:

Helmet Reflective Vest Safety Boots Gloves Goggles Others

CLIENT DECLARATION

I confirm that the information supplied above is true and correct. I have disclosed any known security or safety concerns relating to the site. I agree to facilitate reasonable access to the project for Beryl Engineering & Properties Ltd. personnel. I understand that Beryl Engineering & Properties Ltd. reserves the right to postpone or cancel any visit where safety, accessibility or operational concerns exist.

Client Signature & Date

Company Representative & Date

OFFICE USE ONLY

Risk Assessment

Low Medium High

Visit Approved

Yes No

Assigned Engineer

Transportation Arrangement

Approval Date

Approved By

Remarks

BERYL ENGINEERING & PROPERTIES LTD. | 10 Block 6, Merit Plaza, Opposite Justrite Superstore, Akobo, Ibadan, Oyo State BEP-FRM-001 | Rev 1.0

Fill in the fields above on your phone or computer, then either tap "Email Completed Form to Beryl" to send your responses straight to our office, or tap "Print / Save as PDF" to keep or print a copy. You can also print a blank copy at our office to fill in by hand.