Checklist for Enclosed Space Entry

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: