CONFINED SPACE ENTRY PERMIT Erect signs and barriers

JSA
Keep work site free of trip hazards
Comply with MSDS
Adhere to lifting plan/method statement

Equipment to be isolated when left unattended

Control the working hours Measure the temperature Water station

Permit Registry No.
Others :
THIS PERMIT IS AUTOMATICALLY SUSPENDED UPON ACTUATION OF THE GENERAL ALARM
5. PERSONAL(PERSONNEL) PROTECTIVE EQUIPMENT & SAFETY EQUIPMENT REQUIRED
AND MUST BE RETURNED TO THE PTW OFFICE FOR RE-ISSUE BEFORE RESTARTING WORK
Eye protection Face shield Full chemical suit Fire Blanket Safety harness Eye Wash Station
1. SPECIFICATION OF WORK
Hearing protection Dust mask Paper Coveralls Inertial reels Work lifevest Radio
Work Location : System (Item NO.) :
Head protection Foot protection Fire Extinguisher Life Line Escape (BA) Set Rubber Boots
Work Description : INITIAL ENTRY NORMAL ENTRY
Rigger Gloves Personnel Gas Detector Industrial Gloves Welding shield Tripod OSR Equipment
Cold Weather Clothing Ice and Snow Traction Fire Retardant Clothing Emergency Shower Fresh air mask Full/hair face gas mask
Equipment & Tools to be used :
Gas Detection : O2 CH4 H2S CO Other :
Validity : This Permit is valid from DATE Hrs to DATE Hrs
Others :
Requested by : Signed : ※ Task must be clearly described.
6. GAS ANALYSES OR INITIAL GAS TEST(Authorized Gas Tester)
2. SAFETY CHECK
8 hourly 4 hourly Continuous Others : Authorized Gas Tester
YES NO NA* YES NO NA* Date Name
A. Equipment Preparation 7 Have minutes of prescribed been reviewed Time Initials
1 Has been thoroughly drained 8 Are adequate gas analysis Combustible (%) Date
2 Has been isolated by 9 Are cordoning / warning sign put up Toxic/H2S Time
- Blinds Oxygen (%)
Signature
- Disconnecting C. Adjacent work site precautions Signature
3 Has been water flushed 1 Is hazards from adjacent work taken into ※ To be performed at least every 8hrs ※ Usable O2 CH4 H2S
4 Has been steamed consideration ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. other sheet CO Other
5 Has been purged with inert gas 2 Are close by sewage drains etc., sealed ※ Comments/Remarks :
6 Has been ventilated
7. APPROVAL & ISSUE
B. Site preparations/ precautions D. Prime mover and other isolations
1 Will lighting be used during entry 1 Has been mechanically isolated Step1. Reviewed by ( Contractor Engineer )
2 Is the site cleared of combustible/toxic 2 Has been isolated from other power sources Date : Time : Name : Signed :
materials 3 Electrically isolated and tagged Comments :
3 Is adequate fire-fighting equipment 4 Has power source been disconnected Step2. Reviewed by ( HSE Authorized representative )
located to the work site Isolation slip No. Date : Time : Name : Signed :
4 Are entry and escape adequate (ladder etc.) 5 Has been isolated from radio active source Comments :
5 Have monitoring personnel been
adequately equipped and informed Step3. Approved by ( Construction Authorized representative )
6 Are life-line, safety harness and breathing Date : Time : Name : Signed :
equipment readily available NA * - Not Applicable Comments :
Step4. Accepted by (Subcontractor Task Supervisor / Site Manager)
3. HAZARDS IDENTIFIED
I have read and understand the above conditions and precautions and declare that I accept responsibility for
Extreme weather Flammable materials Explosives Noise High Voltage
carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
Confined space Electrical Spark Danger of falling Tripping/Slipping Hazard Low Voltage carry out any other work, and that I will notify the Contractor engineer(HEC) upon completion/suspension of this work.
Awkward Access/Egress Welding sparks Vehichle Traffic Hot materials Manual handling Date : Time : Name : Signed :

Toxic gases/fumes Eqpmt causing sparks Lifting operation Working at Height Severe/Adverse Weather 8. RE-VALIDATION ( Compulsory RE-VALIDATION of the work permit each shift - to Continue work )
Limited/poor lighting Moving machinery Pintch points Live Equipment Sharp edges Subcontractor HEC HEC - HSE Subcontractor HEC HEC - HSE
Date Validity Time Date Validity Time
(Task Supervisor) Site in-charge (Coordinator) (Task Supervisor) Site in-charge (Coordinator)
Radioactive Source Vibration Excavation Collapse Pressurized Hose Failure Unguarded Opening
Lines/hoses under pressure Hazardous Substances Underground Utility Overhead Power Line Dropped Object
Others : Signature Signature Signature Signature Signature Signature

4. PRECAUTION TO BE TAKEN
Thoroughly ventilated Fire hose run out and pressurised Provided with suitable access and egress Signature Signature Signature Signature Signature Signature
9. PERMIT CLOSE-OUT ( CLOSURE )
Gas test required Fire resistance blanket/habitat erected Area free of flammable/combustible materials
Closed by(Subcontractor) Accepted by (HEC CM) Registered by (Permit Coordinator/HEC HSE)
Maintain radio contact Depressurised Earthed for static
Date Time Date Time Date Time
Water flushed Secure loose objects Drained free of liquids Signed Signed Signed

Firewatcher present Containers for welding rods to be provided System Electrically Isolated
Cross-Referenced Documents : YES NO
Firewatch extinguisher Work area kept wet System Mechanically Isolated ※ NOTE
Attached File : YES NO