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ENCLOSED SPACE ENTRY PERMIT

Rev: 05 01-July-2018

WORK DESCRIPTION AND LOCATION

Vessel Location of Ship

(Sea/Port/Anchor) :
Enclosed Space Permit No.

Reason for entry

Previous Cargo/Contents JSA Number/Date

Permit valid from Date: Expires at Date:

(max 8 hrs) Time: Time:
Access Point/Exit point

SECTION 1 - PRE-ENTRY PREPARATION & SAFETY CHECKS (checked by Responsible Officer*)

YES NA
Has the space been segregated by blanking off or isolating all connecting pipelines or valves and electrical
 
power/equipment, Lock out / Tag out procedures followed as applicable?
Have valves on all pipelines serving the space been secured to prevent their accidental opening?  
Has the space and surrounding area been cleaned?  
Date/ Time Gas Reading Max Limit* Date/ Time Gas Reading Max Limit*
Oxygen(% Vol) ≥ 20.9% H2S (ppm) <2.5 ppm
HC (% LFL) < 1% LFL Benzene (ppm) <0.5 ppm
Other Gases CO <12.5 ppm

Maximum Value of toxic gas is not to exceed 50% of the TLV

Has the atmosphere been tested and confirmed safe for entry based on the readings noted and limits noted
 
above?
Has the space been thoroughly ventilated, tested and found safe for entry?  
Have arrangements been made to continue ventilation during occupancy of the space and during work break?  
Have arrangements been made to repeat atmosphere testing at regular interval during occupancy and after work
 
breaks?
Are rescue and resuscitation equipment available for immediate use by the entrance to the space?  
Has a “Attendent” been designated to be in constant attendance at the entrance of the space?  
Has the Watch Officer (bridge, engine room, cargo control room) been advised of the planned entry?  
Has a system of communication between the “Link Man” at the entrance and those entering the space been
 
tested and emergency signals agreed?
Are emergency and evacuation procedures established and understood by all personnel involved with the
 
enclosed space entry?
Are access and illumination adequate?  
Are portable lights and all equipment used appropriate type in good working conditions, approved and inspected
 
prior entry?
Are personnel using the correct PPE, provided with rescue harness and where practicable lifelines?  
Has a detailed JSA been understood by all personnel involved?  
Is BA Set ready for use at entrance, Have the pre-donning checks on the BA Set carried out successfully, Those
 
entering the space are familiar with the use of BA sets?
Is the portable and personal gas measuring equipment calibrated and ready for use?  
Are the hoses used with gas measuring instrument of sufficient length to reach the tank bottom?  

SECTION 2 – PRIOR ENTERING CHECKS

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ENCLOSED SPACE ENTRY PERMIT
Rev: 05 01-July-2018

(To be checked by the person authorised as Team Leader in presence of all personnel entering the space)
YES NA
I have read and understood your Personal Marine Safety Card - Entry into Enclosed Space.  
I have instructions or permission by the Master or nominated Responsible Officer to enter the enclosed space?  
I am completely satisfied with all the relevant checks in Section 1 completed by Responsible Officer.  
I have agreed and understand all communication procedures including the emergency signal.
 
Emergency evacuation procedures have been agreed and understood.  
BA Set is ready for use at entrance, The pre-donning checks on the BA Set carried out successfully.  
Rescue and resuscitation equipment available for immediate use by the entrance to the space  
I am aware that the space must be immediately vacated in the event of ventilation or communication failure, or
atmosphere tests show a change from agreed safe criteria?
 
I have agreed to report at interval of ………… minutes. .(Max time limit 10 minutes )  
SECTION 3 – AUTHORISATION
COMPLETION OF SECTIONS 1-2 ARE GRANTED BY:
Name Signature
Responsible Officer* Supervising entry:
Authorised Team Leader:
Attendant:
Officer of Watch (OOW)
Personnel entering enclosed space:
Personnel entering enclosed space:
Personnel entering enclosed space:

ENTRY AUTHORISED BY :
Master:
Date: Time:
SECTION 4a – REPETITIVE ATMOSPHERE CHECKS (To be filled out by the Responsible Officer*)
Company Safety Limits: Threshold Limit Value – Time Weighted Average (TLV-TWA)

LFL < 1% Benzene =1ppm

Oxygen >20.9% H2S =5ppm
CO =25ppm
Toxic Gases <50% of TLV-TWA
Space Date/Time Last cargo % % H2S CO Other Initials of
(if Applicable) Oxygen LEL ppm ppm (Pls Responsible Officer
Specify)

Atmosphere readings are to be taken prior to commencement of the job, at intervals not exceeding 2hrs and after every short
break prior resumption of work to ensure the validity of this permit.
SECTION 4b – ENTRY LOG (To be filled out by the Responsible Officer */OOW)
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ENCLOSED SPACE ENTRY PERMIT
Rev: 05 01-July-2018

Is the space being

Initials of person
Name of person

ventilated (Y/N)

supervising the

enclosed space
continuously

Checks (Y/N)

entering the
Atmosphere

entry/ OOW
Responsible
Date / Time

Initials of
Time out
entering

Time in

Officer
SECTION 5 – PERMIT CANCELLATION
Yes NA
System and space returned to normal service condition  
Notices and Securing arrangements related to the permit have been removed  
The work area and equipment is in a safe condition.  
RESPONSIBLE OFFICER* - (signature):

AUTHORISER – Master ( Signature)

Date / Time:

INSTRUCTIONS
 This permit relates to entry into enclosed spaces should be completed by the Responsible Officer/ Engineer and
submitted to the Master for authorisation.
 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.
 Testing for specific toxic contaminants should be guided by information contained in the MSDS for the particular
cargo carried and that previously carried.
 Maximum Validity of the permit is 8 Hours.
 Work shall not be taken up if answer is 'no' to any of the questions in Section 1 and 2.
 The permit will be rendered invalid if any of the conditions noted in the checklist change.
 A tool box meeting, where the JSA is discussed, MUST precede the issuance of a work permit.
 This permit is to be displayed at the work location.
 In the event that the Responsible Officer needs to enter the enclosed space, this must be subject to the permission of
the Master; Master shall then appoint another officer as a Responsible officer / Engineer.
 Attendant means a person who is suitably trained within the safety management system, maintains a watch over
those entering the enclosed space, maintains communications with those inside the space and initiates the
emergency procedures in the event of an incident occurring.
 *RESPONSIBLE OFFICER FOR ENCLOSED SPACE ENTRY ON DECK – CHIEF OFFICER
 *RESPONSIBLE OFFICER FOR ENCLOSED SPCACE ENTRY IN MACHINARY SPACES – CHIEF ENGINEER / 1 ST ASST
ENGINEER