Roof Access Form

Introduction MAC Facilities Department provides access keys to approved persons who need to perform work on MAC roofs. Approved persons may include tenants, contractors, vendors or MAC employees who need to install new equipment, maintain or repair equipment or systems, including the roof itself. Scheduling and coordination of roof work must occur through MAC Facilities and other applicable MAC departments. The ASSA CLIQ lock installed on all roof access doors is an electronic lock that records access of each person that enters the roof by their individual key. Their access is recorded by the name issued on the key, their company, and the date and time they entered the roof. As holder of the ASSA CLIQ key, you agree to take responsibility in assuring that when you enter or leave the roof, the roof access door is secured. If you escort another individual onto the roof, you are responsible for that person’s actions and safety. All persons accessing the roof must comply with OSHA fall protection requirements in addition to the use of appropriate fall protection equipment. MAC roofs are vital areas to the existence and operation of this airport and you, as a carrier of these special keys, must assure appropriate conduct of all personnel involved in roof activities.

Procedures Keys will be issued only to persons with the proper level of MAC security badge identification. To obtain a key or keys, complete these steps:  Obtain a Key Request Form from the MAC Facilities Management office (LT-3115), over the phone (612-726-5225) or by fax (612-726-5320).  Review roof plans in the MAC Facilities Management office (LT-3115). On the key request form, please note: o the closest access roof door / access point to what you are trying to fix or maintain, and record that door number; o required fall protection measures (e.g. railings, fall restraint, and/or fall arrest equipment including harnesses, lanyard lengths and anchor points).  Complete the rest of the Key Request Form. After all required signatures are in place, the key request will be processed.  When approved, pick up key. It will be programmed only for those doors listed on the Key Request Form. If you already have a “CLIQ” key, the door will be programmed after signature approval. Once your request has been approved and keys have been issued, use the following procedures to access the roof:  Before roof entry, contact Emergency Communications Center (ECC). 612-726-5577. for clearance.  When your maintenance or repair is completed, exit through the same access roof door/access point. Check door so that it is secured behind you.  Contact Emergency Communications Center (ECC) and state that you are clear of the roof.

Penalties for Violations You and your company are responsible for any and all OSHA penalties and citations resulting from your access to MAC roofs. Further, your company will indemnify and hold the MAC harmless for any injuries, liabilities or OSHA citations the MAC receives as a result of your actions. Improper use of keys or improper actions on the roof could result in the following penalties:  Revocation of the deposits associated with the issuance of keys;  Revocation of MAC issued security badges which includes the associated deposits;  A letter documenting the violation and an administrative penalty of $1,000;  Prosecution under applicable Federal and/or local security directives and /or guidelines.

I have read, understood and will follow the requirements detailed above.

Name (Print) ______Signature ______

Company (Print) ______Date ______