This permit is for entry into a PUMPROOM for the purpose of monitoring or inspection ONLY.
IT IS NOT A PERMIT TO WORK. If work is to be carried out, then a separate Work Permit is necessary.
This document is abbreviated. It cannot and must not be used as a substitute for knowledge, of the relevant Company procedures, required for using this permit.
Before entering a PUMPROOM all appropriate checks listed on this permit must have been carried out and the permit duly authorised.
SECTION 1. To be completed and signed by the Officer in charge.
Location: _______________________ Date : _________________
Reason(s) for Entry: ___________________________________________________________________
|YES||NO||Remarks – Mandatory if “NO”|
|1||Are the Pumproom ventilation fans running and working correctly?|
|2||Have arrangements been made for continuous ventilation, including during work breaks?|
|3||Is the fixed gas test equipment on and working accurately?|
|4||Is the pump room rescue equipment available for immediate use?|
|5||Does the person entering the pumproom have a hand held radio?|
|6||Are ELSAs fully charged and operational|
|7||Is access to work area in the pumproom well lit, with any hazardous areas highlighted or roped off?|
|8||Have all personnel who are to enter the pumproom been briefed on the entry and evacuation procedure?|
|9||Has a responsible person been informed that the pumproom is being entered and have effective communications been established?|
ATMOSPHERE TEST – RECORD OF RESULTS
|Hydrocarbon (HC)||< 1% LEL|
|Hydrogen Sulphide (H2S)||10 ppm|
|Benzene (C6H6)||1 ppm|
|Carbon monoxide (CO)||50 ppm|
|Sulphur dioxide (SO2)||5 ppm|
|Other toxic gas|
ENDORSEMENTS: MAXIMUM time between gas readings = 4hrs
|Time||HC||O2||H2S||C6H6||CO||SO2||Other toxic gas||Signature|