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? |
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(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: | |||||||||||||||||||
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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 |