Category Archives: Forms And Checklists

Enclosed Space Entry Permit

ENCLOSED SPACE ENTRY PERMIT  
 
M.V./S.S.: POSITION Page 1 of  4
  VALID FOR PERIOD FROM hrs DATE:
  (See Note 1) TO hrs DATE:
 
Space to be Entered:  
(See Note 2)
 
 
 
Reason for Entry:  
 
 
 
( If any form of work or use of tools is anticipated then a cold work / hot work permit is required as appropriate )
 
Access and Exit Points:  
 
 
 
( Detail also alternative accesses which could be utilised for rescue / evacuation )
 
Name of Team Leader entering:  
 
 
Names of other persons entering:  
 
 
 
(Page 4 shall be maintained recording time of entry and exit of all personnel)
 
Name of O.O.W. on Deck/Bridge:  
 
Name of “Link Man” Outside Space:  
 
Communications: (a) Method  
  (b) Frequency  
 
Time and Date of Entry:  
 
Anticipated Time/Date of Completion:  
 
Actual Time/Date of Completion:  
(To be entered when entry completed)
   
Type of ventilation in use:  
 
 
   
   

 

M.V./S.S.: POSITION Page 2 of  4
  CONDITION OF AREA / SPACE
  CHECKLIST YES NO REMARKS
  SECTION 1 – PRE-ENTRY PREPARATIONS ( To be checked by the responsible officer)
                 
Has the space been segregated by blanking off              
  / isolating all connecting pipelines or have all              
  valves on pipelines serving the space  been              
  secured to prevent accidental opening ?              
                 
1.1 Has the procedure for lock – out / tag –out              
  been followed              
                 
Has the space been thoroughly ventilated              
  and continuous ventilation maintained ?              
Has the space been cleaned ?              
Have arrangements been made for frequent

Atmosphere checks to be made during the entry and after work breaks?

             
  (record on p 4)              
Reading of oxygen,hydrocorbon or toxic gas              
  Concentration taken and recorded              
                 
                 
Main and alternative access (if applicable) and              
  illumination adequate?              
                 
S.C.B.A/C.A.B.A. positioned in the immediate vicinity of              
  the space with pressure guage indicating full ?              
                 
8 Rescue Harness correctly positioned?              
                 
Resuscitation Equipment positioned              
  in the immediate vicinity of the space?              
                 
ELSA Units and Oxyalarms operational and              
  used?              
                 
Is all equipment used of an approved type ?              
                 
Has a ‘link man’ been designated to stand by the access to the space and has the OOW              
  Been advised of the planned entry?              
  System and frequency of communication              
  Understood by all              
                 
Are emergency and escape procedures              
  Established and understood ? (Action Plan)              
                 
Team Leader fully conversant with the relevant              
  Section of the Safety and Environmental manual?              
Has risk arrangement carried out (if applicable)              
                 
The items above should be answered YES.  However under certain extenuating circumstances an item may be answered with a NO.  Where this is the case a risk assessment is to be conducted on the particular checklist item.  Only if the risk is acceptable and additional precuations are put in place can the entry continue.  A suitable remark must be made if a question is answered with a NO.

 

 
    Page 3 of 4
   
  CHECKLIST YES NO REMARKS
SECTION 2 – PRE-ENTRY CHECKS  ( To be checked by the person authorised as leader of the team entering the space).
                 
Section 1 of this permit has been              
  Completed?              
                 
I am aware the space must be evacuated              
  Immediately if the ventilation fails or              
  Atmosphere tests change from the              
  Agreed safe criteria?              
                 
I have agreed the communications              
  Procedures?              
                 
I have agreed to report at intervals of             Should not be more than 15
    minutes?            
                 
Emergency evacuation procedures have              
  Been agreed and understood?              
                 
I understand that this permit is for entry              
  Only and that any form of work with              
  Tools requires issue of  a cold work / hot              
  Work permit as required ?              
                 
  Pre-entry tests were: (See notes 3 & 4)
  Oxygen   % Vol  
  Hydrocarbon   %LFL (Less than 1%  LFL)  
  Toxic Gas   ppm (specify type(s) of gas)  
         
THIS PERMIT BECOMES INVALID AND MUST BE RENEWED IF THE VENTILATION STOPS OR IF ANY OF THE CONDITIONS ON PAGE 1 CHANGE
 
Note 1 The validity of this permit is not to exceed 8 hrs.
Note 2 Only one enclosed space should be entered at any one time.  If entry into more than one space is required approval to be obtained.
Note 3 Readings should be taken at three levels if practical and the highest reading recorded.
Note 4 Testing for specific toxic contaminants should be guided by information contained in the MSDS for the particular cargo carried and that previously carried..
NOTE: Ready to be taken with rentibatum stopped
Team Leader Signature :  
(must be a senior officer)  
Chief Officer’s Signature:  
Or  
Chief Engineer’s Signature :  
   
Master’s  Signature:  
 
   
   
 

 

Page 4 of 4
    Date/

Time

Name

Of  Person

Entering

Venting continuous since last entry? (Y/N) % LFL %

02

ppm H2S ppm Other Time

In

Time

Out

Initials

OOW or

responsible

Person

                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
 
THIS PERMIT BECOMES INVALID AND MUST BE RENEWED IF THE VENTILATION STOPS OR IF ANY OF THE CONDITIONS ON PAGE 1 CHANGE