CARGO TANK ENTRY PERMIT FOR CHEMICAL TANKER

MT: Risk Assessment Approval Date: Time: hrs

(Note: This permit shall be issued within 12 hours from time of approving risk assesment.)
This permit is valid: From hrs Date To hrs Date
(Validity of this permit should not exceed 8 Hours)
A. This permit can only be issued basis availability of valid 'Risk Assessment (S - 6CT.29a F) form for relevant tanks.
B. Single permit can be used for multiple tanks however more than two simultaneous entries shall not be allowed at any given
time.
C. This permit shall not be issued if any of below items is marked as 'NO'.
D. Designated Officer shall ensure that necessary safety checks as listed below are carried out and shall issue a permit. 'Safety
Representative' will verify that safety checks have been done and will countersign the permit.
Section 1 - To be checked by a responsible person: Yes No N/A
1.1 Is rescue & resuscitation equipment as per QHSE Manual Section 9.14.3 available for immediate
use at convenient nearby location? Location of Emergency Rescue Equipment: _______________________________
1.2 Has communication between stand by person & those entering the space been agreed & tested?
1.3 Are emergency and evacuation procedures established and understood?
1.4 If vessel is in port, has approval been obtained from port authorities?

 Safety Checks / Cargo Tanks 

Has the space been segregated by blanking off or
isolating all connecting pipelines?
Have the valves on all pipelines serving the space
been secured to prevent their accidental opening?
Has IG / PV branch valve been segregated by
blanking or isolating connecting pipelines?
Has inert gas pressure of adjacent tanks been
lowered to reduce possibility of any inter-tank
leakage?
Has the space been cleaned and thoroughly
ventilated?
Have arrangements been made for continuous
ventilation during period of occupation & work
breaks?
Oxygen (O2 > 20.8%)
Atmosphere
HC (LEL < 1%)
checks at
Toxic Gas (1): ______ (TLV)
____m height;
Toxic Gas (2): ______ (TLV)
Oxygen (O2 > 20.8%)
Atmosphere
HC (LEL < 1%)
checks at
Toxic Gas (1): ______ (TLV)
____m height;
Toxic Gas (2): ______ (TLV)
Oxygen (O2 > 20.8%)
Atmosphere
HC (LEL < 1%)
checks at
Toxic Gas (1): ______ (TLV)
____m height;
Toxic Gas (2): ______ (TLV)
Note:
1) Pre-entry atmosphere tests should be carried out from outside the space. Cargo tank atmosphere sampling at various depths/ locations will depend upon the construction of the
compartment. When tests are being carried out from deck level, ventilation should be stopped and a minimum period of about 10 minutes should be allowed to elapse before
readings are taken.

Persons entering the space

Name: Signature: Rank:
Name: Signature: Rank:
Name: Signature: Rank:
Name: Signature: Rank:
Designated Attendant (1): Name: ____________________ Rank: _____________ Tanks assigned: ______ / ______ / ______ / ______
Designated Attendant (2): Name: ____________________ Rank: _____________ Tanks assigned: ______ / ______ / ______ / ______
Responsible Person: Name: _______________________ Rank: _________________ Date: _______________ Time: _______________

Signature of 'Safety Representative' * : Name: ___________________ Rank: ___________ Date: _____________ Time: ___________
Note:
a) Safety Representative will be the one identified in Section 4 of relevant 'Risk Assessment form (S - 6CT.29a F).
b) One(1) Designated attendant in constant attendance at the entrance of the tank.

Section 2 - Approval:
I confirm that the atmosphere in the compartment is tested and found satisfactory. Safeguards are in place to protect
personnel from the hazards that are identified and appropriate means for controlling entry are in place. All hazards,
communications, evacuation, etc. have been explained to the crew entering the tank(s).
Signature of Master or Designated Officer: Name: _________________ Rank: _________ Date: ______________Time: ___________
Note: Designated Officer will be the one identified in Section 4 of relevant 'Risk Assessment Form (S - 6CT.29a F).

Section 3 - On completion of work

The work has been completed and all persons under my supervision, equipment and tank tags have been withdrawn.
Signature of Designated Officer: Name: _____________________ Rank: _____________ Date: ______________ Time: ___________
THIS PERMIT IS RENDERED INVALID SHOULD ANY OF THE CONDITIONS NOTED IN THIS CHECKLIST CHANGE.

Generated by PARIS on 31 Mar 2021

Rev. 1  03/21  S ‐ 6CT.29b C