Page 5 - Dainfern Valley

IT’S HOLIDAY TIME!

Reference: BAROQUE
Quality Management System

Procedure Manual
Annexure: N/A
Quality Management System
Reference: BAROQUE
Revision No.: 01
Reference Document
Annexure: N/A
Procedure Manual
Dainfern Valley Holiday
Date: 29/06/2015
Revision No.: 01
Reference Document
Page 1 of 1
Instruction Form

Page 1 of 1
Instruction Form
Date: 29/06/2015 Dainfern Valley Holiday

FULL NAME: ……………………………………………………….
The Festive Season is the time of year when FULL ADDRESS: ………………………………………………….
FULL NAME: ……………………………………………………….

FULL ADDRESS: ………………………………………………….
everyone has the opportunity to take a break, ……………………………………………………….

……………………………………………………….
get some well-earned rest and have fun with

………………………………………………………..
………………………………………………………..
the family. DETAILS OF DESTINATION: …………………………………….

DETAILS OF DESTINATION: …………………………………….

…………………………………………………………… TEL NO: ……………………………….
…………………………………………………………… TEL NO: ……………………………….

Please remember to complete the holiday DEPARTURE DATE:…………………………………. TIME: ………………………………….
DEPARTURE DATE:…………………………………. TIME: ………………………………….

leave form if you are going away so that RETURN DATE: …………………………………….. TIME: …………………………………..
RETURN DATE: …………………………………….. TIME: …………………………………..

security can do the necessary security checks. IN CASE OF EMERGENCY PLEASE CONTACT
IN CASE OF EMERGENCY PLEASE CONTACT
TELEPHONE NUMBER
NAME & SURNAME
This process and procedure is essential in NAME & SURNAME TELEPHONE NUMBER
1)

1) 2)
maintaining our premier Estate, with security 2) 3)
3)

NAME OF PERSONS STAYING AT HOME
as a main priority. Thank you in advance for NAME OF PERSONS STAYING AT HOME TIME/BETWEEN
NAME
CELL NUMBER
1)

your co-operation in this matter. NAME CELL NUMBER TIME/BETWEEN

2)

1)

2) 3)
4)
3)

4) I AM LEAVING A PILOT LAMP SWITCHED “ON” (DESCRIPTION) ………………………

I AM LEAVING A PILOT LAMP SWITCHED “ON” (DESCRIPTION) ………………………
………………………………………………………………………………………………………..
ANIMALS
………………………………………………………………………………………………………..
AGGRESSIVE
NAME
ANIMALS YES/NO
1)
2)
NAME YES/NO
AGGRESSIVE
1) 3) YES/NO
YES/NO

2) YES/NO
YES/NO
3) ANY OTHER INSTRUCTIONS/INFORMATION:………………………………………………

………………………………………………………………………………………………………
ANY OTHER INSTRUCTIONS/INFORMATION:………………………………………………
I HEREBY AUTHORISE THE CONTACT PERSON TO ATTEND TO/ARRANGE ANY EMERGENCY REPAIRS
THAT MAY BE REQUIRED DURING MY ABSENCE.
(PLEASE DELETE WHICHEVER IS NOT APPLICABLE)
………………………………………………………………………………………………………
Prior to your departure please attend to the following:
I HEREBY AUTHORISE THE CONTACT PERSON TO ATTEND TO/ARRANGE ANY EMERGENCY REPAIRS
Test your alarm by phoning the control room on 469-0812
1)
THAT MAY BE REQUIRED DURING MY ABSENCE.
2)
Make sure that the contact person staying at your house knows how to operate the alarm and
(PLEASE DELETE WHICHEVER IS NOT APPLICABLE)
has the control room phone number.
Prior to your departure please attend to the following:
No keys are left in the doors.
3)
1) 4) Test your alarm by phoning the control room on 469-0812
Deliveries (milk/newspapers, etc) have been cancelled.
No firearms are left on the property.
2) 5) Make sure that the contact person staying at your house knows how to operate the alarm and
FSS absolves itself of any responsibility and/or liability in the event of contractors working on
6) has the control room phone number.
3) No keys are left in the doors.
the property in your absence and/or any person staying on the property.
4) Deliveries (milk/newspapers, etc) have been cancelled.
5) No firearms are left on the property.
FSS absolves itself of any responsibility and/or liability in the event of contractors working on
6)
SIGNATURE:…………………………………………….. DATE: ………………………………………………………
the property in your absence and/or any person staying on the property.

SIGNATURE:…………………………………………….. DATE: ………………………………………………………
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