| 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)
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| 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:
(Chief Officer/Chief Engineer/Master) |
Signature : | Date :
Time: |
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- Gas samples should be taken using portable gas instruments, from several depths and through as many openings as possible in order to get a good cross section representation of the compartment’s atmosphere. Ventilation should be stopped for about 10 minutes before pre entry atmosphere tests are taken.
- Only those entries marked * need to be completed for pump room entry.
- Chief Officer is authorised to sign/close the permit, ONLY for routine pump room entry/inspection.
- Copy of the permit is to be displayed on site.
- TLV-TWA for various gases – CO – 25 PPM, H2S- 5 PPM, BENZENE – 1 PPM
