[Select Quarter] [Select Year] [Enter Dormitory Name] Management Report Form

A) Dorm Occupancy (as of last day of the quarter)
Any changes to URA’s Approved Occupancy Load since the last reporting? If yes, please provide details	Select One
New Approved Occupancy Load: Enter Figure
Actual Occupancy Breakdown by gender Breakdown by nationality Breakdown by industry sector	Total: Enter Figure
Male: Enter Figure Female: Enter Figure
Indian: Enter Figure	Bangladeshi: Enter Figure	Chinese: Enter Figure
Thai: Enter Figure	Others: Enter Figure
Construction Enter Figure	Manufacturing: Enter Figure	Marine: Enter Figure
Process: Enter Figure	Services: Enter Figure
Maximum occupancy on any level in dorm	No. of residents: Enter Figure
Vacant Beds	Total no. of Vacant Beds: Enter Figure
No. of Vacant Beds reserved by companies: Enter Figure
No. of Vacant Beds available for rental: Enter Figure
Rental Rates	Without additional services No. of beds rented: Enter Figure Lowest rate ($): Enter Figure Highest rate ($): Enter Figure	With additional services* No. of beds rented: Enter Figure Lowest rate ($): Enter Figure Highest rate ($): Enter Figure

* Additional services include packages offered to residents e.g. bed with meal plans and laundry services.

B) Usage of Dorm Amenities/Facilities
Usage of Indoor Recreational Facilities	Gym: Select One TV Room: Select One Reading/Multi-Purpose Room: Select One Others (pls. indicate) Enter Details: Select One
Usage of Outdoor Recreational Facilities	Hard Court: Select One Others (pls. indicate) Enter Details: Select One
Usage of Cooking Facilities	Stoves: Select One Food Preparation Area: Select One
Usage of Beer Garden	Weekdays: Select One Weekends: Select One
Usage of Sick Bays No. of occupied days in the quarter	Bed 1	Bed 2	Bed 3	Bed 4
Enter Figure	Enter Figure	Enter Figure	Enter Figure

Low usage – Infrequent or occasional usage even during peak hours Med usage – moderately used or approximately half full during peak hours High usage – usually crowded or heavily utilised during peak hours

C) Programmes
Programmes/Activities held in the quarter	Frequency	Date (Last event)	Details	Turnout
Name the Activity	Select Frequency	Enter Date	Enter Details	Select One
Name the Activity	Select Frequency	Enter Date	Enter Details	Select One
Name the Activity	Select Frequency	Enter Date	Enter Details	Select One
Name the Activity	Select Frequency	Enter Date	Enter Details	Select One
Name the Activity	Select Frequency	Enter Date	Enter Details	Select One
Name the Activity	Select Frequency	Enter Date	Enter Details	Select One

D) Transport Arrangements to Workplace
Transport Type	Public transport (Bus only)	Public transport (MRT only)	Public transport (Bus and MRT)	Company-arranged transport (directly to workplace)	Others (e.g. walk, bicycle, car, motorcycle)
No. of residents	Enter Figure	Enter Figure	Enter Figure	Enter Figure	Enter Figure
Percentage of residents	Enter %	Enter %	Enter %	Enter %	Enter %
For residents taking company-arranged transport directly to workplace, please provide a breakdown of vehicle type used	No. of buses: Enter Figure	No. of lorries: Enter Figure	No. of cars: Enter Figure
If applicable, list the no. of residents taking arranged transport to a public transport node	Company arranged: Enter Figure	Licensee arranged: Enter Figure

E) Security Arrangements
No. of times CCTV footage is submitted to Police for investigation within the quarter	Enter Figure
Are security arrangements provided by a third-party? If yes, please complete the rest of this section	Select One
Total no. of security officers	Enter Figure
Details of chief security officer	Name: Enter Details Contact No.: Enter Details
Any changes to security provider company since last reporting? If yes, please provide details in section G	Select One

F) Cleaning Arrangements
Are cleaning arrangements provided by a third-party?	Select One
Any changes to cleaning provider company since last reporting? If yes, please provide details in section G	Select One
Frequency of Cleaning	Living Quarters: Select Frequency (Others)
Toilets: Select Frequency (Others)
Indoor Recreational Facilities: Select Frequency (Others)
Outdoor Recreational Facilities: Select Frequency (Others)
G) Third-Party Services (For Regular Services e.g. security, cleaning, catering, laundry)
Any changes to service provider(s) since the last reporting? If yes, please provide details below	Select One
Type of Service (e.g. cleaning, catering, security)	Name of Service Provider Company	Address of Service Provider Company
Enter Details	Enter Details	Enter Details
Enter Details	Enter Details	Enter Details
Enter Details	Enter Details	Enter Details
Enter Details	Enter Details	Enter Details

H) Feedback/Grievances From Residents*
Details of Feedback/Grievances: Enter Details Date of Feedback/Grievances: Enter Date Date resolved: Enter Date Action taken (if any): Enter Details
Details of Feedback/Grievances: Enter Details Date of Feedback/Grievances: Enter Date Date resolved: Enter Date Action taken (if any): Enter Details

* Highlight only major feedback/grievances received. Separately, you are required to maintain a register of all feedback/faults/grievances received from residents under Licensing Condition 3.5.4.

I) Major Incidents*
Security related: Select One Were the Police called in: Select One Details of Incident (e.g. what happened, location, nationalities of parties involved): Enter Details Date of Incident: Enter Date Action taken (if any): Enter Details
Security related: Select One Were the Police called in: Select One Details of Incident (e.g. what happened, location, nationalities of parties involved): Enter Details Date of Incident: Enter Date Action taken (if any): Enter Details

* Highlight only major incidents that have a major impact on residents’ well-being. Examples include but are not limited to – water or electrical supply disruption, Wi-Fi disruption, pest infestation, mass food poisoning.

J) Outstanding Rental Arrears (as of last day of the quarter)
1	Name of company: Enter Details Total rental arrears ($): Enter Figure How many workers: Enter Figure Starting date of rental arrears: Enter Date Operator’s plan/action taken to recover rental arrears: Enter Details
2	Name of company: Enter Details Total rental arrears ($): Enter Figure How many workers: Enter Figure Starting date of rental arrears: Enter Date Operator’s plan/action taken to recover rental arrears: Enter Details
3	Name of company: Enter Details Total rental arrears ($): Enter Figure How many workers: Enter Figure Starting date of rental arrears: Enter Date Operator’s plan/action taken to recover rental arrears: Enter Details
4	Name of company: Enter Details Total rental arrears ($): Enter Figure How many workers: Enter Figure Starting date of rental arrears: Enter Date Operator’s plan/action taken to recover rental arrears: Enter Details
5	Name of company: Enter Details Total rental arrears ($): Enter Figure How many workers: Enter Figure Starting date of rental arrears: Enter Date Operator’s plan/action taken to recover rental arrears: Enter Details

Declaration

☐ I declare that the information provided in this form is accurate and complete. I am aware that providing false and/or incomplete information is an offence under Section 11(3) of the Foreign Employee Dormitories Act (FEDA), and I may be fined up to $50,000 and/or imprisoned for up to 12 months.

Instructions

This quarterly management report form should be submitted via email as an attachment to mom_feda@mom.gov.sg using a corporate email account belonging to the dorm manager or authorised representative of the dorm operator. The email should also include the email signature of the person (dorm manager or authorised representative of the dorm operator) submitting the application form. The person must also provide further personal details in the table below:

Name: Enter Details
Designation: Enter Details
Company: Enter Details
NRIC/FIN: Enter Details
Email address: Enter Details
Contact no.: Enter Details (Office) Enter Details (Handphone)

Quarter	Report to be submitted by
Jan – Mar	30th April
Apr – Jun	31st July
Jul – Sep	31st Oct
Oct – Dec	31st Jan