CONFINED SPACE

ENTRY PERMIT
F/EHS/13
Rev 00

Permit No Project
Name of the Welder:
Company:
Work Description:
Location:
Date Required From To
Validity:
SAFETY PRECAUTIONS TO BE TAKEN
# Precautions Yes No Remarks If Any
1 Has the detailed inspection is carried out for confined space
work?
2 Has gas test done?
3 Have proper access and egress defined?
4 Has only intrinsically safe electrical tools ensured?
5 Any watch personnel posted till finishing the job?
6 Has proper ventilation and illumination ensured?
7 Has proper barricading of the area done?
8 Has the supervisor informed the associated risks to workers?
9 Are all required personnel protective appliances provided?
10 Has emergency procedure detailed and informed to all
concerned?
PERMIT INITIATOR
I Confirm that the safety precautions specified shall be adhered to
Name: ………………………………..

Signature………………………. Company……………………………….. ….
Date: ……………………
I hereby authorize the operation to proceed subject to full compliance with the necessary precautions by
the permit receiver:-
Project Manager / Engineer Permit Controller
Name: Name:
Signature: Signature:
Date: Date:
Note:- 1. Copy of the permit must be made available with the working crew and should be
returned to site HSE department on completion of the work.
2. Only certified welders are permitted to do the welding / hot work.
3. Report any incident to your immediate authority at once.