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 : _________________   Time :___________________   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

GAS

Maximum Permitted

Actual

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

Oxygen (O2)

20.8%

ENDORSEMENTS:  MAXIMUM time between gas readings = 4hrs

Time

HC

O2

H2S

C6H6

CO

SO2

Other toxic gas

Signature