Whsmp · OPW16/0021

                                                                              Confined Space Entry Permit
                                                                                                                   HB-HSEQ-F-075
                                                                                                                       Version: 2

  NOTE: A RISK ASSESSMENT/SWMS for the confined space entry is to also be undertaken and attached to this permit


Section 1 – General Details
Project & Address:
Description & Location of
Confined Space:

Task(s) to be Undertaken:


Section 2 – Controls
Isolation Controls:
Space needs to be isolated from:                              Must Provide Details Regarding Isolation Points & Isolation Method
                                              Yes      No     to be Used:
Water / Gas / Steam / Chemicals
Mechanical / Electrical drives
Hydraulic / Electric / Gas / Power
Sludge / Deposits / Wastes
Auto fire extinguishing systems
Other:
Locks &/or tags will be affixed to
isolation points

Purging, Ventilation & Atmospheric Monitoring Controls:
Space requires the following:        Yes     No    Must Provide Details Regarding Atmospheric Controls to be Used:
Depressurisation
Opening / venting
Continuous purging / extraction
Atmospheric testing required for:                             Type of testing / monitoring required:
 O2                     CO                          H2S     Initial only – Prior to entry and each subsequent
 LEL                    CO2                                day
NH4                                                            Continuous for atmospheric contaminants
 Other:                                                       Continuous for flammable contaminants
Communication & Stand-by Controls:
Minimum requirements will include: Yes                 No     Provide Clarifying Details as Required:
One stand-by person
Two/more stand-by personnel
Rescue team
Communication via voice / direct sight
Communication via radio
Communication via hand signals / other
means

Rescue / Retrieval Considerations:
Minimum provisions required:                                  Provide Additional Clarifying Details – Specifically for Complex
                                              Yes      No     Scenarios:
Stand-by person to individually handle
Safety harness/rescue kit in vicinity with
competent user(s)
Specific access platforms/scaffolding
erected
Specific fire fighting provisions
First aid kit in vicinity
Other: