FIRST 250MMSCFD

TRAIN OF KM500
GAS TREATMENT
PLANT

Confined Space Procedure (Site)

HAV-EXT-HS-PRO-0082

EXTERRAN - REVIEW STAMP

Proj. No.: 4996 P.O. No.: 89005190

DOCUMENT REVIEW CODES:

1 2

Approved & Accepted as Final. Approved & Accepted as Marked.

WORK may proceed. Revise & Re-Submit. WORK may
proceed.

3 4

Rejected & Returned. Revise and Review NOT required. For

Re-Submit. WORK shall NOT information only. WORK may
proceed. proceed.

Acceptance of this document by Exterran does not relieve the CONTRACTOR or

Supplier/Vendor of any responsibility for compliance with the terms and conditions of
the Contract/PO.

Name:
Akano Temitope Signature:
Date:
13 September 2021

B 13.09.2021 REISSUED FOR APPROVAL UE OY BO

A 06.05.2021 ISSUED FOR APPROVAL HY OY BO
REV. DATE REVISION STATUS PREPARED BY CHECKED BY APPROVED BY
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CONTENTS

1. PURPOSE ............................................................................................................................................................................. 3
2. BACKGROUND................................................................................................................................................................... 3
3. ASSIGNMENT OF RESPONSIBILITY ............................................................................................................................ 3
4. TRAINING ........................................................................................................................................................................... 7
5. IDENTIFICATION OF HAZARDS AND EVALUATION OF CONFINED SPACES ................................................ 9
6. ENTRY PERMITS ............................................................................................................................................................. 11
7. ENTRY PROCEDURES ................................................................................................................................................... 13
8. EMERGENCY RESPONSE ............................................................................................................................................. 16
9. ATTACHMENTS............................................................................................................................................................... 17
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1. PURPOSE
The purpose of HAVATEK’s (Hereafter referred to as CONTRACTOR) Confined Space Program is to set
procedures that will ensure workers safe entry into confined spaces and permit-required confined spaces to
perform routine tasks associated with their employment.

2. BACKGROUND
A confined space is defined as any location that has limited openings for entry and egress, is not intended
for continuous employee occupancy, and is so enclosed that natural ventilation may not reduce air
contaminants to levels below the threshold limit value (TLV). Examples of confined spaces include:
manholes, stacks, pipes, storage tanks, trailers, tank cars, pits, sumps, hoppers, and bins. Entry into confined
spaces without proper precautions could result in injury, impairment, or death due to:
a) An atmosphere that is flammable or explosive;
b) Lack of sufficient oxygen to support life;
c) Contact with or inhalation of toxic materials; or
d) General safety or work area hazards such as steam or high pressure materials.
e) Structure collapse, flood, severe weathers

3. ASSIGNMENT OF RESPONSIBILITY
a) Contractor

In administering this Confined Space Program, CONTRACTOR will:

1. Monitor the effectiveness of the program.

2. Will provide atmospheric testing and equipment as needed.
3. Will provide personal protective equipment as needed.
4. Will provide training to affected employees and supervisors.
5. Preview and update the program on at least an annual basis or as needed.

b) Program Manager

HSE Manager is responsible for managing the Confined Space Program, and shall:
1. Ensure that a list of confined spaces at all project worksites is maintained.
2. Ensure that canceled permits are reviewed for lessons learned.
3. Ensure training of personnel is conducted and documented.
4. Coordinate with outside responders.
5. Ensure that equipment is in compliance with standards.
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6. Ensure that the CONTRACTOR HSE supervisor and HSE supervisors of subcontractors in
charge of confined space work shall:

a. Ensure requirements for entry have been completed before entry is authorized.
b. Ensure confined space monitoring is performed by personnel qualified and trained in
confined space entry procedures.
c. Ensure a list of monitoring equipment and personnel qualified to operate the equipment
is maintained by the HSE department
d. Ensure that the rescue team has simulated a rescue in a confined space within the past
twelve (6) months.
e. Know the hazards that may be faced during entry, including the mode (how the
contaminant gets into the body), signs or symptoms, and consequences of exposure.
f. Fill out a permit.
g. Determine the entry requirements.
h. Require a permit review and signature from the authorized Entry Supervisor.
i. Notify all involved employees of the permit requirements.
j. Post the permit in a conspicuous location near the job.
k. Renew the permit or have it reissued as needed (a new permit is required every shift).
l. Determine the number of Attendants required performing the work.
m. Ensure all Attendant(s) know how to communicate with the entrants and how to obtain
assistance.
n. Post any required barriers and signs.
o. Remain alert to changing conditions that might affect the conditions of the permits (i.e.,
require additional atmospheric monitoring or changes in personal protective equipment).
p. Change and reissue the permit, or issue a new permit as necessary.
q. Ensure periodic atmospheric monitoring is done according to permit requirements.
r. Ensure that personnel doing the work and all support personnel adhere to permit
requirements.
s. Ensure the permit is canceled with the work is done.
t. Ensure the confined space is safely closed and all workers are cleared from the area.

c) Entry Supervisors

Contractor shall assign an entry supervisor and shall be qualified and authorized to approve
confined space entry permits. The Entry Supervisor(s) shall be responsible for:

1. Determining if conditions are acceptable for entry.

2. Authorizing entry and overseeing entry operations.
3. Terminating entry procedures as required.
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4. Serving as an Attendant, as long as the person is trained and equipped appropriately for that
role.
5. Ensuring measures are in place to keep unauthorized personnel clear of the area.
6. Checking the work at least twice a shift to verify and document permit requirements are
being observed (more frequent checks shall be made if operations or conditions are
anticipated that could affect permit requirements).
7. Ensuring that necessary information on chemical hazards is kept at the worksite for the
employees or rescue team.
8. Ensuring a rescue team is available and instructed in their rescue duties (i.e., an onsite team
or a prearranged outside rescue service).
9. Ensuring the rescue team members has current certification in first aid and cardiopulmonary
resuscitation (CPR).

d) Attendants

Attendant(s) shall be stationed outside of the confined workspace. The attendants shall be selected
and assigned by entry supervisor. The Attendant(s) shall:

1. Be knowledgeable of, and be able to recognize potential confined space hazards.

2. Maintain a sign-in/sign-out log with a count of all persons in the confined space, and ensure
all entrants sign in and out.
3. Monitor surrounding activities to ensure the safety of personnel.
4. Maintain effective and continuous communication with personnel during confined space
entry, work, and exit.
5. Order personnel to evacuate the confined space if he/she:
a) observes a condition which is not allowed on the entry permit;
b) notices the entrants acting strangely, possibly as a result of exposure to hazardous
substances;
c) notices a situation outside the confined space which could endanger personnel;
d) notices a hazard within the confined space that has not been previously recognized or
taken into consideration;
e) must leave his/her work station; or
f) must focus attention on the rescue of personnel in some other confined space that he/she
is monitoring.

6. Immediately summon the Rescue Team if crew rescue becomes necessary.

7. Keep unauthorized persons out of the confined space, order them out, or notify authorized
personnel of an unauthorized entry.
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e) Rescue Team

The Rescue Team members shall:

(1) Complete a training drill using mannequins or personnel in a simulation of the confined
space prior to the issuance of an entry permit for any confined space and at least annually
thereafter.
(2) Respond immediately to rescue calls from the Attendant or any other person recognizing a
need for rescue from the confined space.
(3) In addition to emergency response training, receive the same training as that required of the
authorized entrants.
(4) Have current certification in first aid and CPR.

Rescue team may be kept around confined space work area by the entry supervisor

f) Entrants/Affected Employees

Employees who are granted permission to enter a confined space shall:

1. Read and observe the entry permit requirements.
2. Remain alert to the hazards that could be encountered while in the confined space.
3. Properly use the personal protective equipment that is required by the permit.
4. Immediately exit the confined space when:
a. they are ordered to do so by an authorized person;
b. they notice or recognize signs or symptoms of exposure; (See table 1 below for samples)
c. A prohibited condition exists; or
d. When standby person warned the entrants

5. Alert Attendant(s) when a prohibited condition exists and/or when warning signs or
symptoms of exposure exist.

LOW EXPOSURE
GAS TYPES IMPACTS ON HUMAN BODY
LIMIT
Inhalation of concentrations of
500-1000 (ppm) will cause rapid
10-20 ppm for 10
Hydrogen Sulfide unconsciousness and death
minutes
through respiratory paralysis and
asphyxiation.
25 ppm-50 ppm for 8 Symptoms of mild acute
CO
hours poisoning include
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lightheadedness,
confusion, headaches, vertigo,
and flu-like effects; larger
exposures can lead to significant
toxicity of the central nervous
system and heart, and even death.
Exposure to concentration more
than 5 ppm for 1-6 hours may
cause severe airways obstruction,
hypoxemia (insufficient
Sulphur dioxide 1-3 ppm for 1-6 hours
oxygenation of the blood),
pulmonary edema (a life
threatening accumulation of fluid
in the lungs), and death.
Chronic low-level inhalation
exposure via inhalation can cause
damage to the respiratory system,
including chronic cough, loss of
appetite, dyspepsia and gradual
Nitric oxide 25 ppm loss of strength.
Prolonged skin exposure may
cause potentially harmful
amounts of Nitric Oxide to enter
the body via absorption through
the skin.

4. TRAINING
CONTRACTOR and subcontractors shall provide training so that all employees whose work is regulated
by this Confined Space Program acquire the understanding, knowledge, and skills necessary for the safe
performance of their duties in confined spaces.
a) Training Frequency

Responsible Person shall provide training to each affected employee:

1. before the employee is first assigned duties within a confined space;
2. before there is a change in assigned duties;
3. when there is a change in permit space operations that presents a hazard for which an
employee has not been trained; and
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4. When CONTRACTOR has reason to believe that there are deviations from the confined
space entry procedures required in this program, or that there are inadequacies in the
employee’s knowledge or use of these procedures.

The training shall establish employee proficiency in the duties required in this program, and shall
introduce new or revised procedures, as necessary, for compliance with this program.
b) General Training

All employees who will enter confined spaces shall be trained in entry procedures. Personnel
responsible for supervising, planning, entering, or participating in confined space entry and rescue
shall be adequately trained in their functional duties prior to any confined space entry. Training
shall include:
1. Explanation of the general hazards associated with confined spaces.
2. Discussion of specific confined space hazards associated with the facility, location, or
operation.
3. Reason for, proper use, and limitations of personal protective equipment and other safety
equipment required for entry into confined spaces.
4. Explanation of permits and other procedural requirements for conducting a confined space
entry.
5. A clear understanding of what conditions would prohibit entry.
6. Procedures for responding to emergencies.
7. Duties and responsibilities of the confined space entry team.
8. Description of how to recognize symptoms of overexposure to probable air contaminants in
themselves and co-workers, and methods for alerting the Attendants.
Refresher training shall be conducted as needed to maintain employee competence in entry
procedures and precautions.

c) Specific Training

1. Training for atmospheric monitoring personnel shall include proper use of monitoring
instruments, including instruction on the following:
 Proper use of the equipment;
 Calibration of equipment;
 Sampling strategies and techniques; and
 Exposure limits (PELs, TLVs, LELs, UELs, etc.).
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2. Training for Attendants shall include the following:

 Procedures for summoning rescue or other emergency services; and

 Proper utilization of equipment used for communicating with entry and
emergency/rescue personnel.

3. Training for Emergency Response Personnel shall include:

 Rescue plan and procedures developed for each type of confined space that is
anticipated to be encountered;
 Use of emergency rescue equipment;
 First aid and CPR techniques; and
 Work location and confined space configuration to minimize response time.

4. Verification of Training

Periodic assessment of the effectiveness of employee training shall be conducted by HSE Trainer.
Training sessions shall be repeated as often as necessary to maintain an acceptable level of
personnel competence.

5. IDENTIFICATION OF HAZARDS AND EVALUATION OF CONFINED SPACES

a) Survey

HSE Manager shall ensure a survey of the worksite is conducted to identify confined spaces. This
survey can be partially completed from initial and continuing site characterizations, as well as other
available data (i.e., job hazard analysis). The purpose of the survey is to develop an inventory of those
locations and/or equipment at project that meet the definition of a confined space. This information
shall be communicated to personnel, and appropriate confined space procedures shall be followed
prior to entry. The initial surveys shall include air monitoring to determine the air quality in the
confined spaces. The potential for the following situations shall be evaluated by HSE Manager and/or
HSE Site Supervisor
 flammable or explosive potential;
 oxygen deficiency; and
 presence of toxic and corrosive material.
 Configuration of the confined space
 Mechanical hazards
 Engulfment in fluids/materials

The requirements above shall be applied by subcontractors

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b) Hazard Reevaluation

The HSE Manager and/or site HSE supervisor shall identify and reevaluate hazards based on
possible changes in activities or other physical or environmental conditions that could adversely
affect work. A master inventory of confined spaces shall be maintained. Any change in designation
of a confined space will be routed to all affected personnel by HSE Manager or site HSE
supervisor.

c) Pre-Entry Hazard Assessment

A hazard assessment shall be completed by Entry supervisor prior to any entry into a confined
space. The hazard assessment should identify:
 the sequence of work to be performed in the confined space;
 the specific hazards known or anticipated; and
 the control measures to be implemented to eliminate or reduce each of the hazards to an
acceptable level.

No entry shall be permitted until the hazard assessment has been reviewed and discussed by all
persons engaged in the activity. Personnel who are to enter confined spaces shall be informed of
known or potential hazards associated with said confined spaces.

d) Hazard Controls

Hazard controls shall be instituted to address changes in the work processes and/or working
environment. Hazard controls must be able to control the health hazards by eliminating the
responsible agents, reduce health hazards below harmful levels, or prevent the contaminants from
coming into contact with the workers.
The following order of precedence shall be followed in reducing confined space risks.

e) Engineering Controls

Engineering controls are those controls that eliminate or reduce the hazard through implementation
of sound engineering practices.
Ventilation is one of the most common engineering controls used in confined spaces. When
ventilation is used to remove atmospheric contaminants from a confined space, the space shall be
ventilated until the atmosphere is within the acceptable ranges. Ventilation shall be maintained
during the occupancy if there is a potential for the atmospheric conditions to move out of the
acceptable range.
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When ventilation is not possible or feasible, alternate protective measures or methods to remove
air contaminants and protect occupants shall be determined by entry supervisor prior to authorizing
entry.
When conditions necessitate and can accommodate continuous forced air ventilation, the following
precautions shall be followed:

 Employees shall not enter the space until the forced air ventilation has eliminated any
hazardous atmosphere.
 Forced air ventilation shall be directed so as to ventilate the immediate areas where an
employee is or will be present within the space.
 Continuous ventilation shall be maintained until all employees have left the space.
 Air supply or forced air ventilation shall originate from a clean source.

f) Work Practice (Administrative) Controls

Work practice (administrative) controls are those controls which eliminate or reduce the hazard
through changes in the work practices (i.e., rotating workers, reducing the amount of worker
exposure, and housekeeping).
Confined space training shall be all involved personnel.
Safety signs shall be replaced at the entrance and around of the confined space activity area.

g) Personal Protective Equipment (PPE)

If the hazard cannot be eliminated or reduced to a safe level through engineering and/or work
practice controls, PPE should be used. Entry supervisor shall determine the appropriate PPE
needed by all personnel entering the confined space, including rescue teams. PPE that meets the
specifications of applicable standards shall be selected in accordance with the requirements of the
job to be performed.

6. ENTRY PERMITS
The Confined Space Entry Permit is the most essential tool for assuring safety during entry in confined
spaces with known hazards, or with unknown or potentially hazardous atmospheres. The entry permit
process guides the supervisor and workers through a systematic evaluation of the space to be entered. The
permit should be used to establish appropriate conditions. Before each entry into a confined space, an
entry permit will be completed by Entry supervisor. The Entry supervisor will then communicate the
contents of the permit to all employees involved in the operation, and post the permit conspicuously near
the work location.
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a) Key Elements of Entry Permits

A standard entry permit shall contain the following items:

1. Space to be entered.
2. Purpose of entry.
3. Date and authorized duration of the entry permit.
4. Name of authorized entrants within the permit space.
5. Means of identifying authorized entrants inside the permit space (i.e., rosters or tracking
systems).
6. Name(s) of personnel serving as Attendant(s) for the permit duration.
7. Name of individual serving as Entry Supervisor, with a space for the signature or initials of
the Entry Supervisor who originally authorized the entry.
8. Hazards of the permit space to be entered.
9. Measures used to isolate the permit space and to eliminate or control permit space hazards
before entry (i.e., lockout/tagout of equipment and procedures for purging, ventilating, and
flushing permit spaces).
10. Acceptable entry conditions.
11. Results of initial and periodic tests performed, accompanied by the names or initials of the
testers and the date(s) when the tests were performed.
12. Rescue and emergency services that can be summoned, and the means of contacting those
services (i.e., equipment to use, phone numbers to call).
13. Communication procedures used by authorized entrants and Attendant(s) to maintain contact
during the entry.
14. Equipment to be provided for compliance with this Confined Space Program (i.e., PPE,
testing, communications, alarm systems, and rescue).
15. Other information necessary for the circumstances of the particular confined space that will
help ensure employee safety.
16. Additional permits, such as for hot work, those have been issued to authorize work on the
permit space.

b) Permit Scope and Duration

The following conditions shall be met before each reentry into the confined space:
1. Atmospheric testing shall be conducted and the results should be within acceptable limits. If
atmospheric test results are not within acceptable limits, precautions to protect entrants
against the hazards should be addressed on the permit and should be in place.
2. Entry supervisor shall verify that all precautions and other measures called for on the permit
are still in effect.
3. Only operations or work originally approved on the permit shall be conducted in the
confined space.
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A new permit shall be issued, or the original permit will be reissued if possible, whenever changing work
conditions or work activities introduce new hazards into the confined space. Detailed information has
been given in PTW procedure.

7. ENTRY PROCEDURES
When entry into a confined space is necessary, either the Entry Supervisor or may initiate entry
procedures, including the completion of a confined space entry permit. Entry into a confined space shall
follow the standard entry procedure below.

a) Prior to Entry

The entire confined space entry permit shall be completed before a standard entry. Entry shall be
allowed only when all requirements of the permit are met and it is reviewed and signed by an
Entry Supervisor. The following conditions must be met prior to standard entry:
1. Affected personnel shall be trained to establish proficiency in the duties that will be
performed within the confined space.
2. The internal atmosphere within the confined space shall be tested by entry supervisor with a
calibrated, direct-reading instrument.
3. Personnel shall be provided with necessary PPE as determined by the Entry Supervisor.
4. Atmospheric monitoring shall take place during the entry. If a hazardous atmosphere is
detected during entry:

a) personnel within the confined space shall be evacuated by the Attendant(s) until the space
can be evaluated by Entry Supervisor to determine how the hazardous atmosphere
developed; and
b) Controls shall be put in place to protect employees before reentry.

b) Opening a Confined Space

Any conditions making it unsafe to remove an entrance cover shall be eliminated before the cover
is removed. When entrance covers are removed, the opening shall be promptly guarded by a
railing, temporary cover, or other temporary barrier that will prevent anyone from falling through
the opening. This barrier or cover shall protect each employee working in the space from foreign
objects entering the space. If it is in a traffic area, adequate barriers shall be erected.
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c) Atmospheric Testing

Atmospheric test data is required prior to entry into a confined space. Atmospheric testing is
required for two distinct purposes: (1) evaluation of the hazards of the permit space, and (2)
verification that acceptable conditions exist for entry into that space. If a person must go into the
space to obtain the needed data, then Standard Confined Space Entry Procedures shall be followed.
Before entry into a confined space, Entry Supervisor shall conduct testing for hazardous
atmospheres. The internal atmosphere shall be tested with a calibrated, direct-reading instrument
for oxygen, flammable gases and vapors, and potential toxic air contaminants, in that order.

Testing equipment used in specialty areas shall be listed or approved for use in such areas by Entry
Supervisor.

1. Evaluation Testing

The atmosphere of a confined space should be analyzed using equipment of sufficient

sensitivity and specificity. The analysis shall identify and evaluate any hazardous
atmospheres that may exist or arise, so that appropriate permit entry procedures can be
developed and acceptable entry conditions stipulated for that space.

2. Verification Testing

A confined space that may contain a hazardous atmosphere shall be tested for residues of
all identified or suspected contaminants. The evaluation testing should be conducted with
specified equipment to determine that residual concentrations at the time or testing and
entry are within acceptable limits. Results of testing shall be recorded by the person
performing the tests on the permit. The atmosphere shall be periodically retested
(frequency to be determined by Entry Supervisor) to verify that atmospheric conditions
remain within acceptable entry parameters.

3. Acceptable Limits

The atmosphere of the confined spaces shall be considered to be within acceptable limits
when the following conditions are maintained:

a) oxygen: 19.5 percent to 23.5 percent;

b) flammability: less than 10 percent of the Lower Flammable Limit (LFL); and
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c) Toxicity: less than recognized American Conference of Governmental Industrial

Hygienists (ACGIH) exposure limits or other published exposure levels [i.e., OSHA
Permissible Exposure Limits (PELs) or National Institute of Occupational Safety and
Health (NIOSH) Recommended Exposure Limits (RELs)].

d) Isolation and Lockout/Tag-out Safeguards

All energy sources that are potentially hazardous to confined space entrants shall be secured,
relieved, disconnected, and/or restrained before personnel are permitted to enter the confined
space. Equipment systems or processes shall be locked out and/or tagged out as required by the
CONTRACTOR Lockout/Tag-out Program (Isolation Program) prior to permitting entry into the
confined space. In confined spaces where complete isolation is not possible, Entry Supervisor shall
evaluate the situation and make provisions for as rigorous isolation as practical. Special
precautions shall be taken when entering double-walled, jacketed, or internally insulated confined
spaces that may discharge hazardous material through the vessel’s internal wall.
Where there is a need to test, position, or activate equipment by temporarily removing the lock or
tag or both, a procedure shall be developed and implemented to control hazards to the occupants.
Any removal of locks, tags, or other protective measures shall be done in accordance with the
CONTRACTOR Lockout/Tag-out Program (Isolation Program).

e) Ingress/Egress Safeguards

Means for safe entry and exit shall be provided for confined spaces. Each entry and exit points
shall be evaluated by Entry Supervisor to determine the most effective methods and equipment that
will enable employees to safely enter and exit the confined space.
Appropriate retrieval equipment or methods shall be used whenever a person enters a confined
space. Use of retrieval equipment may be waived by the Entry Supervisor if use of the equipment
increases the overall risks of entry or does not contribute to the rescue. A mechanical device shall
be available to retrieve personnel from vertical confined spaces greater than five (5) feet in depth.

f) Warning Signs and Symbols

All confined spaces that could be inadvertently entered shall have signs
identifying them as confined spaces. Signs shall be maintained in a legible
condition. The signs shall contain a warning that a permit is required before
entry. Accesses to all confined spaces shall be prominently marked. See
sample sign below
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8. EMERGENCY RESPONSE
a) Emergency Response Plan
Emergency Response Plan shall be applied also for confined space works. Another ERP program
may be prepared according to hazards of confined space.

b) Retrieval Systems and Methods of Non-Entry Rescue

Retrieval systems shall be available and ready when an authorized person enters a permit space,
unless such equipment increases the overall risk of entry, or the equipment would not contribute
to the rescue of the entrant. Retrieval systems shall have a chest or full-body harness and a
retrieval line attached at the center of the back near shoulder level or above the head. If harnesses
are not feasible, or would create a greater hazard, wristlets may be used in lieu of the harness.
The retrieval line shall be firmly fastened outside the space so that rescue can begin as soon as
anyone is aware that retrieval is necessary. A mechanical device shall be available to retrieve
personnel from vertical confined spaces more than five (5) feet (1.50 cm) deep.
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9. ATTACHMENTS

CONFINED SPACE ENTRY CERTIFICATE

(No alteration is allowed on the permit sheet. Valid only if a Main Work Permit is issued and attached.)

Confined Space Entry Certificate No.:____________

This certificate is valid between ... / … / …. … : … and ... / … / …. … : … (Maximum 24 hours
)
1. Confined Space Specification Main Permit No:
Confined Space To Be Entered:
Equipment No. / Location: Work Date / Time: /

2. Precautions To Be Taken (Prior To Initial Gas Test) Permit Controller

Safety Check List (Complete Each Box) Yes/No Initial

1 The above equipment has been removed from service and all personnel concerned have been notified.
The above equipment has been isolated from all sources of dangerous liquids and fumes by blanking and/or
2
disconnecting.
3 The above equipment has been isolated from all hazardous sources including electrical and mechanical power.
4 The above equipment has been freed of all dangerous materials by (state method):
5 Ventilation: natural/air movers installed at:
6 Suitable access and egress has been provided.
7 Risk Assessment completed
3. Entry Precautions Permit Controller

Safety Check List (*complete each box) Yes/No Initial

1 Safety harness/lifelines/lifting equipment (delete as appropriate).
2 Safety watch at man way/entrance.
3 Communication System. i.e. radios
4 Earth leakage circuit breakers.
5 Temporary/portable lighting.
6 Continuous O2 test / O2 test every 4hours (specify) - delete as appropriate
7 Personal gas monitoring equipment.
8 Others
4. Authorization Site Superintendent

I authorize the work which is stated in this Permit. The work can start after the site is completely checked by the permit controller and all
precautions are taken.
Name: Signature: Date: Time:
5. Certificate Acceptance Task Supervisor
I have read and understood the information contained in this certificate and will undertake to work in accordance with the conditions stipulate
dThe person(s) entering the space will be instructed and I will notify the Supervisor when persons under my supervision have exited the space
.
Name: Signature: Date: Time:
6. Certificate Issue Permit Controller
I, the Permit Controller, declare that the above named confined space is safe to enter in accordance with Permit to Work and Confined Space
Entry procedures. Entry must be affected within FOUR HOURS of the time of the initial gas test or the gas test MUST be repeated.
 CONFINED SPACE PROCEDURE (SITE)
Doc. Code: HAV-EXT-HS-PRO-0082 Issue Date: 06.05.2021 Rev. No: B Rev. Date: 13.09.2021 Page No: 18/ 18

Name: Signature: Date: Time:

7. Certificate Completion Task Supervisor / Permit Controller
Task Supervisor: Entry covered by this certificate has been completed and all personnel have been withdrawn

Name: Signature: Date: Time:

Permit Controller:

Name: Signature: Date: Time:

Note: 1st Copy- Displayed at Work Site, 2nd Copy-Permit Office, and 3rd Copy-Applicant
“STOP THE WORK, EVACUATE AREA AND ASSEMBLE AT DESIGNATED ASSEMBLY POINT IN ANY CASE OF EMERGENCY”
Drawings / Sketches / Diagrams Additional Requirements / Remarks

 Oxygen content is within the range of 19.5% and 23.5%;

 Accumulation of flammable or explosive gas is less than 10% of its LEL; and
 Accumulation of toxic gas is less than its permissible exposure level (PEL)
o Carbon dioxide 5000 ppm
o Carbon monoxide 25 ppm
o Hydrogen sulphide 10 ppm
o Mercury 0.025 mg/m3