ENCLOSED SPACE ENTRY PERMIT AMN/SMS 7.5.5/3/8.

15-A

VESSEL NAME :………………… PERMIT No…………….

ENCLOSED SPACE ENTRY PERMIT

This permit relates to entry into any enclosed space and should be completed by the Master or responsible Officer and by the person
entering the space or authorized team leader.
GENERAL
Location/name of enclosed space
(Only one space to be entered each time)
Reason of entry:
This permit is valid from: hrs Date: / / (See Note 1)
to: hrs Date: / /

SECTION 1 – Pre-Entry Preparation

(To be checked by the Master or Responsible Officer) Yes No
 Has a Risk Assessment (R-01) been carried out? (Please record the date of the R-01. Date: ______ Title:_______ )  
 Has the space been thoroughly ventilated? ...................................................................................................................  
 Has the space been segregated by blanking off or isolating all connecting pipelines, valves and electrical
power/equipment? ..........................................................................................................................................................  
 Has the space been cleaned/washed where necessary? ..............................................................................................  
 Has the space been tested and found safe for entry (See Note 2)…………………………………….……………………...  

 PRE-ENTRY ATMOSPHERE TEST READINGS  

 Oxygen ……………………………. % vol (20.8%)
 Hydrocarbon………………………. % LFL (Less than 1%)
 toxic gases………………………… ppm (Less than 50% OEL of the toxic gas)
(See Note 3) By: ……………………..
Time: …..……………...

 Have arrangements been made for frequent atmosphere checks to be made while the space is occupied and after
work breaks? ....................................................................................................................................................................  
 Have arrangements been made for the space to be continuously ventilated throughout the period of occupation and
during work breaks? .......................................................................................................................................................  
 Are access and illumination adequate? ..........................................................................................................................  
 Is rescue and resuscitation equipment available for immediate use by the entrance to the space? ..............................  
 Has the responsible person been designated to be in constant attendance at the entrance to the space?  
Enter Name and Rank:________________________________________________________________......................
 Has the Officer of the Watch (bridge, engine room, cargo control room) been advised of the planned entry? ................  
 Has a system of communication between all parties been tested and emergency signals agreed? ...............................  
 Are emergency and evacuation procedures established and understood by all personnel involved? ............................  
 Is all equipment used in good working condition and inspected prior to entry? ............................................................  
 Are personnel properly clothed and equipped? ..............................................................................................................  
 Have all above been discussed during a formal work plan meeting with all personnel participating to the entry being
present? ..................................................................................................................................................................  
Cross referencing with other permits: Hot work Work aloft Other (specify)
Relevant forms to be completed as appropriate
Person authorized team leader of the entering : Signature:
Responsible Officer for surveying the entry: Signature:
Responsible Officer for safety (C/O) Signature:
Master: Signature:

SECTION 2 - Pre-Entry Checks

(To be checked by the person entering the space or authorized team leader) Yes No
 I have received permission from the Master and instructions from the Responsible Officer to enter the enclosed
space……………………………………………………………………………………………………………………………….  
 Section 1 of this permit has been successfully completed by the Responsible Officer and approved by the Master ...  
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ENCLOSED SPACE ENTRY PERMIT AMN/SMS 7.5.5/3/8.15-A

 I have agreed and understand the communication procedures…………………………………………..……………….…  

 I have agreed upon a reporting interval of _________ minutes……………………………………………………………...  
 Emergency and evacuation procedures have been agreed and are understood…………………………………………  
 I am aware that the space must be vacated immediately in the event of ventilation failure or if atmosphere
tests show a change from agreed safe criteria…………………………………………………………………………...  
SECTION 3 – Breathing apparatus and other equipment
(To be checked jointly by the Master or Responsible Officer and the person who is to enter the space)
Yes No
 Those entering the space and the guard at space entrance is familiar with the breathing apparatus to be used in an
emergency rescue situation ………………………………………………………………………………………………………  
 The breathing apparatus has been tested as follows: ………………………………………..……………………………….
 gauge and capacity of air supply…………………………………..………………….….….……………………………  
 low pressure audible alarm………………………………………………….…….…………………..…………………..  
 face mask-under positive pressure and not leaking……………………..……….……………………..……………...  
 The means of communication have been tested and emergency signals agreed………………………………………....  
 The guard at space entrance has been provided with one rescue harness and lifeline and is familiar with their use
during an emergency rescue situation…………………………………………………………………………………………..  
Signed upon completion of Sections 1, 2 and 3 by:
Master ________________________________________________________ Date_____/_____/_____ Time_________________
Responsible Officer for supervising entry ____________________________ Date_____/_____/_____ Time_________________
Person entering the space
or authorized team leader ____________________________ Date_____/_____/_____ Time_________________

SECTION 4 – Personnel entry (To be completed by the Responsible Officer supervising entry for each person entering the space. Each
person to sign and record the time in /out)
Rank/ Name Signature Time in Time out

SECTION 5 – Completion of job (To be completed by the Responsible Officer supervising entry)
 Job completed Date_____/_____/_____ Time_________________
 Space secured against entry Date_____/_____/_____ Time_________________
 The Officers of the Watch (Bridge, ECR) have been duly informed Date_____/_____/_____ Time_________________
Signed upon completion of Sections 4 and 5 by:
Responsible Officer supervising entry____________________________ Date_____/_____/_____ Time_________________

THIS PERMIT IS RENDERED INVALID SHOULD VENTILATION OF THE SPACE STOP OR IF ANY OF THE CONDITIONS NOTED IN
THE CHECK LIST CHANGE

Notes:
1. The permit should contain a clear indication as to its maximum period of validity, which in any event should not exceed 8
hours.
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 pre-entry atmosphere tests are
taken.
3. Tests for specific toxic contaminants, should be undertaken depending on the nature of the previous contents of the space. In case
another gas is present please specify.
4. The permit should be issued for each space entered separately.
5. Original to be kept in file
6. Permit is valid for 1 working day = 8 hours

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