Checklist for Enclosed Space Entry

Section 1 – PRE-ENTRY PREPARATIONS Yes No
1* Has  a formal  risk assessment been prepared and  discussed by the personnel entering the space ?
2* Pre-entry atmosphere test readings ( using portable monitors )                             Tested  By :-

 

Oxygen………..……………………% vol (21%),                                                   Time : –

 

Hydrocarbon………………………%LFL (less than 1%),

 

Toxic Gases(CO/H2S/Benzene)……..………………….ppm(less than 50 % TLV-TWA of the specific gas)

 

3* Have arrangements been made to repeat atmosphere testing of the space during occupancy and during breaks?
4* Are access and illumination adequate?
5* Have arrangements been made to continue ventilation of the space during occupancy and during breaks?
6* Is rescue and resuscitation equipment available for immediate use by the entrance to the space?
7* Has an attendant been designated to be in constant attendance at the entrance to the space ?
8* Has the Officer of the Watch (Bridge, ECR, CCR) been advised of the planned entry?
9* Has a system of communication between all parties been tested and emergency signals agreed?
10* Is a record maintained for the personnel entering/exiting the space?
11* Are Lock Out tags/notices in place where applicable?
12* Are Plant isolation referred to where applicable?
13* Are portable lights and other equipment available and an approved /certified type?
14* Are personnel entering the space equipped with personal monitors?
ADDITIONAL  CHECKS TO BE CONDUCTED FOR SPACES/TANKS OTHER THAN PUMPROOM
1. Has the space been cleaned, where necessary?
2 Has the space been tested at different levels and locations, using portable monitors?
3 Has the space been positively segregated by blanking off or isolating all connecting pipelines or valves and electrical power/equipment ?
Section 2 – PRE-ENTRY CHECKS

To be recorded by the person authorized  as LEADER of team entering the space

YES N/A
1. I have checked Section 1 of this permit and confirm it has been completed fully?    
2. I am aware that the space must be vacated immediately in the event of ventilation failure or if atmosphere tests change from agreed safe criteria?    
3. I have agreed upon the procedure for communication?    
4. I have agreed upon a reporting interval of ……………..minutes
5. I have agreed and understood the emergency and evacuation procedures  
6. I understand the work to be carried out. We have discussed and agreed the safety measures and I’m satisfied it is safe to commence work Name/Rank /Signature of team leader entering space
SECTION 3 :  AUTHORISATION
I am satisfied that all appropriate safety measures are in place and that the work can be conducted safely. Chief Officer
Work Authorised By: Master / Chief Engineer
SECTION 4 : PERMIT CLOSURE/CANCELLATION
Equipment /system has been de-isolated and returned to the “in-service condition”
All notices and tags removed
The work area and equipment is in a safe condition
 Work Completed                          Permit is time Expired Work suspended
Permit Closed By:

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