A 2.2!11!19 01 Confined Space Work Permit

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Procedure for Working in Confined Space

A-2.2/11-19-1- Confined Space Work Permit

Health Safety & Environment Management

CONFINED SPACE WORK PERMIT

HSE Manual Ref. No. : HSEM GF04062

Site/Office :

Site ID :

Sub Contractor Details (If any) :

Date :

CONFINED SPACE WORK PERMIT

1 Job Details
A)Area/Equipment to which this permit applies B)Work to be done

2 ISOLATION(Specify where necessary) Initials and comments


A)Circuit breaker locked out/fuses withdrawn/isolator locked off
B)Mechanical or physical isolation
C)Valves closed/locked off/spades inserted
D)Pipe lines drained/purged/disconnected/vented to atmosphere
E)Documented isolation procedure is attached
F)Other
3 Precautions ( to be taken as indicated, additional to those specified on other permits)
A)Protective clothing
B)Respiratory equipment
C)Protected electrical equipment
D)Hot work permit
E)Safety belt/ harness
F)Lifting tackle
G)Special ventilation requirements
H)Rescue procedures are in place(specify)
I) Oxygen tests are not/are required at intervals of and results must be recorded overleaf.
4 Additional Permits and Signatures Required Before Work Starts
A)Maximum number of persons allowed in space at any one time
B)Maximum duration each person is allowed for each entry
C)Length of rest pauses to be taken between entries
D)Number of external watchers
E)In my opinion the engineering precautions are adequate Yes /No

All the above precautions have been put in place: Date :

Time:

Shapoorji Pallonji & Co. Ltd. Page 1 of 2


Procedure for Working in Confined Space
A-2.2/11-19-1- Confined Space Work Permit

Health Safety & Environment Management

Issued by PMV In charge:

Verified by HSE Officer :

Project In Charge:

Cancelled by HSE Officer:

Date-
Sign of Site Engineer

To be renewed by Site Engineer in every 24 hrs and should be reissued in 7 days.

If, one day gap in-between, new work permit shall be issued.

Shapoorji Pallonji & Co. Ltd. Page 2 of 2

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