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    Confined Space Entry Permit

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    sindarth raveendrakrishnan
    The document is a confined space entry permit that outlines safety precautions and procedures. It requires contractors to identify risks associated with the work, ensure adequate ventilation and lighting, and isolate energy sources in the confined space. It also mandates that rescue equipment and personal protective equipment be available. Workers must acknowledge the risks and precautions before being issued a permit to enter the confined space.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Confined Space Entry Permit

    Uploaded by

    sindarth raveendrakrishnan
    955 views2 pages
    The document is a confined space entry permit that outlines safety precautions and procedures. It requires contractors to identify risks associated with the work, ensure adequate ventilation and lighting, and isolate energy sources in the confined space. It also mandates that rescue equipment and personal protective equipment be available. Workers must acknowledge the risks and precautions before being issued a permit to enter the confined space.

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    © © All Rights Reserved

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    The document is a confined space entry permit that outlines safety precautions and procedures. It requires contractors to identify risks associated with the work, ensure adequate ventilation and lighting, and isolate energy sources in the confined space. It also mandates that rescue equipment and personal protective equipment be available. Workers must acknowledge the risks and precautions before being issued a permit to enter the confined space.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    955 views2 pages

    Confined Space Entry Permit

    Uploaded by

    sindarth raveendrakrishnan
    The document is a confined space entry permit that outlines safety precautions and procedures. It requires contractors to identify risks associated with the work, ensure adequate ventilation and lighting, and isolate energy sources in the confined space. It also mandates that rescue equipment and personal protective equipment be available. Workers must acknowledge the risks and precautions before being issued a permit to enter the confined space.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    CONFINED SPACE ENTRY PERMIT

    PTW Ref .No: Contractor Name:


    Project Name: Location:
    Starting From Date Time Expected Completion Time
    Work Description:

    Location of job to be performed:


    Tools/Equipments to be used:
    Identify risk associated with this confined space entry
    Liquid or Gas: Under pressure Toxic materials Corrosive materials Flammable materials Hot materials
    Flying particles or sparks: Equipment Generating sparks Other Outside Factors: Wind, weather, sea state
    Electricity: Moving machinery Life work Battery systems Confined space X-Rays
    Lifting operation: Danger of falling Access to work position Other(Specify):
    The following document must be attached with this permit
    Method Statement Risk Assessment Job Safety Procedures Other (specify):
    Precaution require to complete the work safely Yes No Not Applicable
    Is the Vessel Cleaned or Purged?
    Is the Electricity Isolated & LO/TO?
    Is the Mechanical Parts Isolated & LO/TO?
    Is all the Energy sources Isolated?
    Is the Positive Isolation in place & the ICC issued?
    Is there Good Ventilation?
    Is there Good Lightening?
    Is the Fire Fighting Equipment available onsite?
    Is the Rescue Equipment available onsite?
    Are the Employees aware by the expected Hazards?
    Is there a special PPE required? (Respiratory /Hearing protection; Life Vest; Safety Harness)
    Other (specify):
    The following areas / items have been inspected by issuer and receiver
    Fire Extinguisher Type...................... Quantity................ Size....................
    Access/Egress Danger/Warning Sign Lighting Log book register
    Gas Detector Other (specify)
    PPE Required for the activity
    Helmet Safety Shoes Mechanical Gloves Safety Ear Plugs/muff
    Safety goggles Reflective Vest Gas Mask Safety Harness
    Gumboot Dust Mask Others (Specify):
    Issue and acceptance before work
    Acceptance of Work Permission by the person in-charge (Receiver)
    I certify that, I have read and verified this work permit and checklist. I have been informed about the risk assessment results. I am aware of the risks that can be
    exposed to. I commit that I will be in line with all safety rules mentioned in work permit checklist and will not deflect any of them.
    Permit Receiver Name: Signature/Date:
    Authority to proceed by authorized person (Issuer)
    I reviewed the work permission checklist and checked the working conditions. I have reviewed the all aspects of the task/activity and am satisfied with the
    arrangements as detailed in the “risk assessment” have been put in place and certify that the activity detailed above is authorized to proceed

    Permit Issuer Name: Signature/Date:


    Acknowledge by Contractor's Safety Engineer/Officer
    I have reviewed the work permit, and verified entire checklist corresponding to workplace. All the necessary control measures has been taken
    according to risk assessment and additional precautions are implemented.
    Name : Signature/Date:
    Clearance and cancellation after work or Suspension of permit
    Clearance. (Site Manager)
    All men, materials, tools equipment, housekeeping etc. under my charge have been withdrawn. The permitted work is complete / not complete.
    Name: Signature/Date:
    Suspension
    This permit is suspended, I have notified the Authorized person specified that the work is not complete the area / equipment is not safe to use.
    Name: Signature/Date:
    CONFINED SPACE ENTRY PERMIT

    List of additional precaution measures required (SEC Consultant/ Contractor's Safety Engineer/ Officer)

    1.

    2.

    3.

    4.

    5.

    Supervisor Name Permit Ref. No

    Date Location

    Details of Entrants
    Entrant Name ID No Designation Signature

    Details of Attendants
    Attendant Name ID No Designation Signature

    Entry Conditions
     Confined Space Permit must be in place
     If you fit for work (health fitness)
     If you have adequate/appropriate PPE

    Gas Percent Oxygen Hydrocarbon Hydrogen Sulphide NORM Signature of Gas


    DATE (19.5% - 20.5%) (10% LEL) (10 ppm) (Microsivert / Hour) Tester

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