Training Ship Empire State State University of New York MARITIME COLLEGE

ENCLOSED SPACE ENTRY PERMIT DATE:
VALID TIME: FROM: hrs TO: hrs (MAX 12 hrs) IDENTIFY ENCLOSED SPACE: …………………………………………………. REASON FOR ENTERING:………………………………………………………………………… This permit is for entry into an enclosed space for the purpose of monitoring or inspection. If any work is to be performed the appropriate WORK PERMIT must be completed. Before entry into any enclosed space, all safety checks on this permit must be completed. Enclosed spaces include but are not limited to the following: Cargo Tanks, Ballast Tanks, Fuel Tanks, Water Tanks, Lube Oil tanks, Chemical tanks, MSD tanks, Double Bottom tanks, Deep tanks, Cofferdams, Voids, Boiler Drums, Boiler Furnaces and Casings, Chain Lockers and any other normally unventilated closed spaces. CHECK LIST by OFFICER IN CHARGE of ENTRY: The equipment and conditions have been checked and met as follows: Bridge Watch and Engine Room Watch notified Has the space been thoroughly power ventilated Continuous power ventilation in place during entry Space atmosphere gas tested and found SAFE FOR ENTRY Sources of atmospheric contamination from other compartments controlled Pipelines & valves entering or transiting space secured, tagged Ladders or staging required in the space protection harness required and inspected rigging is properly rigged. Hooks & pins moused. Lifelines in place. Continuous atmospheric monitoring required & in place Outside STAND-BY PERSONNEL trained and instructed in rescue Emergency procedures reviewed and understood Adequate proper & safe illumination provided POTENTIAL HAZZARDS IN SPACE IDENTIFIED Rescue equipment in place & ready The following personal protection must be worn: Notations & Special Precautions: As noted above it is considered SAFE or UNSAFE YES NO N/A

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to proceed with entering space.

ENTERING CREW/CADETS: I or WE have read and understand all items on this permit and so indicate by my or our signatures with DATE/TIME as noted below. ___________________________________ _____________________________________ Crew/Cadet signature date-time Crew/Cadet signature date-time ___________________________________ _____________________________________ Crew/Cadet signature date-time Crew/Cadet signature date-time __________________________________ Master/Responsible Officer __________________________________ Person in charge of work team _______________ Time _______________ Time ______________ Date _____________ Date

TIME SPACE EVACUATED of all personnel & equipment_____________, Initials_____________ Enclosed Space Permit, Original copy to Chief Mate or Chief Engineers file

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