PERMIT TO WORK - CONFINED SPACES

• Site conducted

  Select

• Permit number

• Location
  Address

• Site emergency phone numbers

• Conducted on

  Date

• Prepared by

• Contractor

• Contractor Supervisor

• Name(s) of the operative(s) - only named operatives will be allowed access

• Contact(s) of the operatives(s) - mobile phone number(s)

• Access Fobs and access keys requested

• Location of work

• Description of work to be carried out

• Can the work in the confined space be carried out from outside the confined space? (If yes prohibit entry and undertake work from outside.<br>Confirm that work in the confined space cannot be avoided? <br>(there should be sufficient explanation why)

  Yes

  No

  N/A

Physical Measures/actions

• Isolate the area to prevent ingress of harmful substances such as dust and fumes

  Yes

  No

  N/A

• Sludge/deposits removed, where applicable?

  Yes

  No

  N/A

• Space ventilated prior to entry?

  Yes

  No

  N/A

• Plant/valves etc. isolated and locked off as necessary?

  Yes

  No

  N/A

• Clean or purge any tank/vessel before work is undertaken within if necessary

  Yes

  No

  N/A

• Gas test OK prior to entry?

  Yes

  No

  N/A

• Continue to monitor the atmosphere for flammable and or toxic vapours and to ensure there is sufficient oxygen

  Yes

  No

  N/A

Management Control

• Risk assessment conducted identifying the nature of the confined space hazard, any introduced hazards and control measures required?

  Yes

  No

  N/A

• Safe system of work/method statement documented, and workers trained in the findings?

  Yes

  No

  N/A

• Workers appropriately qualified for type of confined space entry and for confined space rescue as applicable? Certificates provided – identities checked?

  Yes

  No

  N/A

• Are sufficient workers allocated to the job? N.B. Lone working not permitted. For a traverse, minimum of 2 persons to enter, plus top man.

  Yes

  No

  N/A

• Competent supervision provided?

  Yes

  No

  N/A

• Rescue plan in place, equipment readily to hand and workers trained?

  Yes

  No

  N/A

• If the rescue plan involves rescuers entering the space, are there at least two staff who are equipped with BA and trained to use it?

  Yes

  No

  N/A

• Means of communication readily available? N.B. Check signal

  Yes

  No

  N/A

• All persons fit to enter?

  Yes

  No

  N/A

• All equipment available as per method statement and within calibration date where applicable including as applicable: winch, tripod, gas monitor, harnesses, PPE, first aid, communications, escape sets/breathing apparatus (BA), intrinsically safe electrical equipment?

  Yes

  No

  N/A

• Is the Contractor approved through Permissions Process and documentation approved?

  Yes

  No

  N/A

• Confirmation that there are no reasonably practicable alternatives to this work to make it safer?

  Yes

  No

  N/A

• Permit Starts

  Date

• Permit Ends

  Date

• The holder of the permit is the employee of a company that has been appointed in accordance with Greystar procedures or is an authorised employee of Greystar.

• The holder of the permit complies with the restrictions and conditions detailed in the permit and attached to it (where applicable)

• The holder of the permit complies fully with all the requirements of the documents HSE Requirements for Contractors, Environmental Site Rules for Contractors, Health and Safety Policy, Environmental Policy

• The holder of the permit ensures that he/she/they (or his/hers/their employees as appropriate) are provided with means of communication in the event of an emergency whilst on this site

• Any change in the scope of work or failure to follow conditions identified in this Permit will automatically invalidate the permit. All proposed changes must be notified to the person who issued the permit (Authorised Person)

• The Permit cannot be transferred between contractors or shifts. In such cases, a new Permit will be issued.

• In an emergency, the permit holder should follow site emergency procedures. In such cases, the permit will automatically become void and a new permit will need to be issued before work can start again.

• Where work is suspended for any reason, the permit will automatically become void and a new permit will be needed before work can start again.

• I understand the scope of works, Greystar Conditions of issue and precautions agreed to be undertaken.

• Permit holder signature

  Sign

• Contractor

• Time Extension

• Start

  Date

• End

  Date

• Reason for Extension

• Authorised person signature

  Sign

• Contractor Supervisor signature

  Sign

• The area has been left in a safe condition, equipment and work materials have been removed.

  Yes

  No

  N/A

• Contractor Supervisor signature

  Sign

• Date & Time

  Date

• Authorised person signature

  Sign

• Date & Time

  Date

• Were any poor health and safety practices identified?

  Yes

  No

  N/A

• Did you have to prohibit work or give any official warnings?

  Yes

  No

  N/A

• Was work being carried out in accordance with the Permit to Work?

  Yes

  No

  N/A

• Was work being carried out in accordance with risk assessments and method statements?

  Yes

  No

  N/A

• Did contractors have copies of the Permit to Work?

  Yes

  No

  N/A

• Was the contractor complying with the site rules?

  Yes

  No

  N/A

• Was the work area suitably protected i.e. fenced / barriered and adequate safety signage provided?

  Yes

  No

  N/A

• Was housekeeping acceptable?

  Yes

  No

  N/A

• Completed by:

  Sign

• Position:

• Date:

  Date