8/12/2019 02_0002

http://slidepdf.com/reader/full/020002 1/2

1) The entry permit should contain a clear indication as to its maximum period of validity which, in any event,should not exceed a normal working day.

2) In order to obtain a representative cross-section of the compartment's atmosphere,samples should be takenfrom several depths and through as many openings as possible. Ventilation should be stopped for about 10

minutes before p re-entry atmosphere tests are taken.3) Tests for specific toxic contaminants, such as benzene and hydrogen sulphide, should be undertaken

depend ing on the nature of the previous contents of the space.

This permit is valid

From hours Date

To hours Date

Location of work

Reason for entry 1 PRE-ENTRY PREPARATIONS (checked by Master or responsibi le off icer)

Has the space been segregated by blanking off or isolating all connecting Yes / No

Have valves on all pipelines serving the space been secured to prevent their Yes / No

Has the space been cleaned? Yes / No

Has the space been thoroughly ventilated? Yes / No

Pre-entry atmosphere tests:

Oxygen: % vol (20%)Hydrocarbon: % LFL (< 1%)Toxic gases: ppm (specify gas and PEL)

Yes / No

Yes / No

Yes / No

Have arrangements been made for frequent atmosphere checks to be made   Yes / No

Have arrangements been made for the space to be continuously ventilated Yes / No

Is adequate illumination provided? Yes / No

Is rescue and resuscitation equipment available for immediate use by the Yes / No

Has the responsible person been designated to stand by the entrance to thespace?

Yes / No

Has the officer of the watch (bridge, engine room, cargo control room) been Yes / No

Has a system of communicaiton between the person at the entrance and those Yes / No

C:\FORMS\02_0002.PDF MT LADON

ENCLOSED SPACE ENTRY PERMITCompany Forms and Check Lists

Date : 03.04.01Rev.No : 1Prep. : MGVApp. : CAPSection : 02Page : 1 of 2

8/12/2019 02_0002

http://slidepdf.com/reader/full/020002 2/2

Are emergency and evacuation procedures established and understood? Yes / No

Is there a system fr recording who is in the space? Yes / No

Is all equipment used of an app roved type? Yes / No

2 PRE-ENTRY CHECKS (checked by person responsibil for team entering space)

Is Section 1 of this permit fully comp leted? Yes / No

I am aware that the space must be vacuated immed iately in the event o f Yes / No

I have agreed to the communication procedures Yes / No

I have agreed upon a reporting interval of__________minutes Yes / No

Emergency and evacuation p rocedures have been agreed and are understood Yes / No

In the circumstances noted it is considered safe to proceed with this enclosed space work.Signed :

 ____________________________ Master/Responsible Officer

 ____________________________ Person carrying out work task or in charge of work team

 3The work has been comp leted and all persons under my supervision, materials andequipment have been withdrawn.

Authorised person in charge: _______________________________________________________ 

Time: ____________________________________ Date: __________________________________ 

THIS PERMIT IS RENDERED INVALID SHOULD VENTILATION OF THE SPACE STOP OR IF

ANY OF THE CONDITIONS NOTED IN THE CHECK LIST CHANGENotes:1. The entry permit should contain a clear indication as to its maximum period o f validity which, in any event,

should not exceed a normal working day.

2. In order to obtain a representative cross-section of the compartment's atmosphere, samples should be taken fromseveral depths and through as many openings as possible. Ventilation should be stopped for about 10 minutesbefore the pre-entry atmosphere tests are taken.

3. Tests for specific toxic contaminants, such as benzene and hydrogen sulph ide, should be undertaken dependingon the nature of the previous contents of the space.

C:\FORMS\02_0002.PDF MT LADON

ENCLOSED SPACE ENTRY PERMITCompany Forms and Check Lists

Date : 03.04.01Rev.No : 1Prep. : MGVApp. : CAPSection : 02Page : 2 of 2

INSTRUCTIONS : To be filled in before each entry into enclosed spaces (including pumproo m) and kep t in the safety officer's file Section 5 fora period of three years.