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? |
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| 4* |
Are access and illumination adequate? |
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| 5* |
Have arrangements been made to continue ventilation of the space during occupancy and during breaks? |
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| 6* |
Is rescue and resuscitation equipment available for immediate use by the entrance to the space? |
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| 7* |
Has an attendant been designated to be in constant attendance at the entrance to the space ? |
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| 8* |
Has the Officer of the Watch (Bridge, ECR, CCR) been advised of the planned entry? |
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| 9* |
Has a system of communication between all parties been tested and emergency signals agreed? |
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| 10* |
Is a record maintained for the personnel entering/exiting the space? |
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| 11* |
Are Lock Out tags/notices in place where applicable? |
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| 12* |
Are Plant isolation referred to where applicable? |
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| 13* |
Are portable lights and other equipment available and an approved /certified type? |
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| 14* |
Are personnel entering the space equipped with personal monitors? |
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| ADDITIONAL CHECKS TO BE CONDUCTED FOR SPACES/TANKS OTHER THAN PUMPROOM |
| 1. |
Has the space been cleaned, where necessary? |
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| 2 |
Has the space been tested at different levels and locations, using portable monitors? |
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| 3 |
Has the space been positively segregated by blanking off or isolating all connecting pipelines or valves and electrical power/equipment ? |
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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? |
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| 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? |
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| 3. |
I have agreed upon the procedure for communication? |
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| 4. |
I have agreed upon a reporting interval of ……………..minutes |
| 5. |
I have agreed and understood the emergency and evacuation procedures |
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| 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” |
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| All notices and tags removed |
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| The work area and equipment is in a safe condition |
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| Work Completed |
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Permit is time Expired |
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Work suspended |
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| Permit Closed By:
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