SSF 015 Enclosed Spaces Permit

• Job Number

• Site

  Select

• Conducted on

  Date

• Site Supervisor

• Location
  Address

THIS PERMIT IS ONLY VALID FOR THE DAY OF ISSUE

• On Every Occasion Confined Space Work Is Carried Out A New Permit Is To Be Issued

• This permit is only to be issued if entry into the confined space is essential.

PART ONE: To be completed prior to entry into enclosed spaces

• Exact Location of the Works

• Scope of Works

• Starting from

  Date

• Planned finish at

  Date

• Competent supervision is on hand throughout job

  Yes

  No

• Why is the response no?

• •Operatives are adequately trained and competent for tasks and use of any PPE that must be worn

  Yes

  No

• Why is the response no?

• There is safe access/egress for operatives

  Yes

  No

• Why is the response no?

• •All necessary equipment and services have been provided (refer to Method Statement)

  Yes

  No

• Why is the response no?

• •There is adequate space to carry out work safely, free from clutter and debris

  Yes

  No

• Why is the response no?

• There are proven means and trained people prepared for evacuating a casualty

  Yes

  No

• Why is the response no?

• Suitable means of communication have been set up for those in the confined space

  Yes

  No

• Why is the response no?

• Incoming services been isolated (gas, electricity, water, fuel, etc.)

  Yes

  No

  N/A

• Why is the response no?

• Installed equipment been isolated

  Yes

  No

  N/A

• Why is the response no?

• Equipment and pipes/tanks have been drained and vented

  Yes

  No

  N/A

• Why is the response no?

• Have potential ingress of fumes or other substances (e.g., excess rainwater if outside) been evaluated and control measures arranged

  Yes

  No

  N/A

• Why is the response no?

• Have residues, sludges or other potential causes of fume been removed

  Yes

  No

  N/A

• Why is the response no?

• Has atmospheric testing for oxygen, toxic fumes, flammables, been carried out

  Yes

  No

  N/A

• Why is the response no?

• Adequate ventilation is arranged

  Yes

  No

  N/A

• Why is the response no?

• Work lighting is installed

  Yes

  No

  N/A

• Why is the response no?

• Additional restrictions, if applicable

• This is to state that I am satisfied that the above location is safe for entry for the work detailed

• Signature of Operative undertaking work - I understand the requirements of this permit.

  Sign

PART TWO: To be completed after Enclosed Space Work is completed for the day.

• I confirm that the work has been completed / partially completed, checked by myself and the area left in a safe and tidy condition. A photograph of the area has been taken. This permit is now cancelled.

  Media

• Signed by Site Supervisor

  Sign

• C. G. Comley & Sons Limited T/A Comley Demolition. Registered office: Southern Way, Rye Common, Odiham, Hook, Hampshire, RG29 1HU. Telephone: 01256 702178. Email: comley@comleydemolition.co.uk Company Registration Number: 01672195