THE ENCLOSED SPACE ENTRY PERMIT
THE ENCLOSED SPACE ENTRY PERMIT
This permit relates to entry into any enclosed space and should be completed by the master or responsible person and by any persons entering the space, e.g. competent person and attendant.
GENERAL
Location/name of enclosed space
Reason for entry .................................................................................................................
This permit is valid from:______ hrs Date ............... to:_______hrs Date ...............
(See Note 1)
SECTION 1 – PRE-ENTRY PREPARATION
(To be checked by the master or nominated responsible person) Yes No
isolating all connecting pipelines or valves and electrical power/equipment? ............ ............
- oxygen ................... % vol (21%)* By:
*Note that national requirements may determine the safe atmosphere range.
- hydrocarbon ......... % LFL (less than 1%)
- toxic gases ............. ppm (less than 50% OEL of the specific gas) Time:
(See note 3)
be made while the space is occupied and after work breaks? ............ ............
ventilated throughout the period of occupation and during work breaks? ............ ............
by the entrance to the space? " "
attendance at the entrance to the space? " "
room) been advised of the planned entry? " "
and emergency signals agreed? " "
understood by all personnel involved with the enclosed space entry? " "
Notes:
1 The permit should contain a clear indication as to its maximum period of validity.
3 Tests for specific toxic contaminants, such as benzene or hydrogen sulphide, should be undertaken depending on the nature of the previous contents of the space.
Signed upon completion of sections 1, by:
Master or nominated responsible person ................... Date .................. Time
Attendant .................................................................... Date .................. Time
Person entering the space .......................................... Date .................. Time
SECTION 2 – PRE-ENTRY CHECKS
(To be checked by each person entering the space)
Yes No
nominated responsible person to enter the enclosed space " "
master or nominated responsible person " "
understood " "
of ventilation failure or if atmosphere tests show a change from
agreed safe criteria " "
Signed upon completion of sections 2 by:
Master or nominated responsible person ................... Date .................. Time
Attendant .................................................................... Date .................. Time
Person entering the space .......................................... Date .................. Time
SECTION 3 – BREATHING APPARATUS AND OTHER EQUIPMENT
(To be checked jointly by the master or nominated responsible
person and the person who is to enter the space)
Yes No
apparatus to be used ............ ............
- gauge and capacity of air supply ............ ............
- low pressure audible alarm if fitted ............ ............
- face mask – under positive pressure and not leaking ............ ............
signals agreed ............ ............
rescue harnesses and, where practicable, lifelines ............ ............
Signed upon completion of sections 3 by:
Master or nominated responsible person ................... Date .................. Time
Attendant .................................................................... Date .................. Time
Person entering the space .......................................... Date .................. Time
Signed upon completion of sections 1, 2 and 3 by:
Master or nominated responsible person ................... Date .................. Time
Attendant .................................................................... Date .................. Time
Person entering the space .......................................... Date .................. Time
SECTION 4 – PERSONNEL ENTRY (To be completed by the responsible person supervising entry) Names .......................................... Time in ......................................... Time out ............................. Signed upon completion of sections 4 by: Responsible person supervising entry …….................... Date ................... Time ............... |
SECTION 5 – COMPLETION OF JOB (To be completed by the responsible person supervising entry) |
• Space secured against entry Date Time ............................ Signed upon completion of sections 5 by: Responsible person supervising entry …….................... Date ................... Time ............... |
Signed upon completion of sections 4 and 5 by:
Responsible person supervising entry …….................... Date ................... Time ...............
THIS PERMIT IS RENDERED INVALID SHOULD VENTILATION OF THE SPACE STOP OR IF ANY OF THE CONDITIONS NOTED IN THE CHECKLIST CHANGE |
Notes:
1 The permit should contain a clear indication as to its maximum period of validity.
2 In order to obtain a representative cross-section of the space's atmosphere, samples
should be taken from several levels and through as many openings as possible.
Ventilation should be stopped for about 10 minutes before the pre-entry atmosphere
tests are taken.
3 Tests for specific toxic contaminants, such as benzene or hydrogen sulphide, should
be undertaken depending on the nature of the previous contents of the space.