Title Page
-
Project
-
Person Completing Permit
-
Permit Number
-
Exact Location of Confined Space
-
Nature of Work
-
Date of Issue
-
Validity of Permit (Max 1 Day)
Gas Tests
-
Gas Tests : Carried out prior to entry by lowering gas detection equipment into confined space.
- Oxygen
- Hydrogen Sulphide
- Explosivity
- Carbon Monoxide
- Others
-
What were the results
-
Type of Gas detection equipment
-
Date of last calibration
The Confined Space is in line with the Safe System of Work
-
Free from Noxious Substances/Sludge
-
Free from Gas and Fume
-
Isolated and locked off from every source of Electricity, Gas, Fume or Liquid
The following Precautions must be taken in line with the Safe System of Work
-
Workforce competent and briefed on safe system of work including testing equipment.
-
Control of Access arrangements in place
-
Emergency Procedure and Rescue facilities in place
-
Effective means of communication to be provided between all parties
-
Stand By/Communications/Top Man available
-
First Aid equipment available
-
No smoking or naked lights
-
Openings to have barrier and suitably signed
-
Protective clothing to be provided (boots/suits/gloves/helmets)
-
Intrinsically Safe tools
-
Adequate Lighting available
-
Tripod, winch, lifeline and harness to be used (certificates in place & inspected prior to each use)
-
Adequate ventilation
-
Escape set breathing apparatus to be worn (ready for use)
-
Continuous gas monitoring at point of work after initial negative 10 minute test prior to entry
Before Work : The recipient is competent and conversant with the safe systems of work:
-
Signature of Supervisor
After Work: All persons have been withdrawn and the workplace has been left safe and this permit is cancelled
-
Signature of Supervisor
Confined space Pre Entry Briefing
-
I confirm that I am medically fit and have proof of training to the correct category of confined space training and in the safety system of work for this operation
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures
-
Confined Space Entry Team Signatures