CSEP No :____________

Confined Space Entry Permit (CSEP)

PTW No :____________

Location Work Site: __________________________________________________________________________

Purpose of Entry:_____________________________________________

Date/Time:___________________

Person in Charge of Work:______________________________________

Expiration:___________________

Supervisor in charge of crew

No of crew

Special Requirements

Yes

Contact No.

No

Yes

Can this Space be impacted on from other work

areas nearby?

Hazardous Material Used?

Is signage and/or barriers required to delineate

work site?

Emergency Rescue
Equipment?

Is atmosphere testing Required?

Exit route defined?

Ventilation type

Fire Extinguishers

Natural

Negative

Positive

Rescuers for Emergency Exit required?

Protective Clothing

Communication Method
Verbal

Radio
PABX

No

Respirator

Hand signal
Others

Isolation required /Carried Out?

Lighting

De-Energize / Close/Stop/Open
Atmosphere
Testing
Tests to be taken

Range

% of Oxygen

19.% 21.5%

% of L.F.L.

Any % Over 10

Carbon Monoxide

<50 ppm

Initial
Reading

Date

Time

Remarks
OK / NO/NA

Toxics
Organic Dust/Vapor

Name & Signature of Authorised Gas Tester (AGT) :_______________________________________

ISSUE

Authorised Person Signature/Name

Competent Person Signature/Name

Date:_____________

Date:________________ Time:_____________

Time:_______

CANCELLATION

Competent Person Signature/Name

Authorised Person Signature/Name

Date:___________

Date:___________

Time:_________

Time:_________

EXTENSION OF PERMIT (for longer than one shift)

Extension is not granted
Approval is granted for permit extension as below:
Date
Night Shift
SSCE Sign.
Day Shift

SSCE Sign.

Eve Shift

SSCE Sign.

THIS WORK PERMIT MUST BE DISPLAYED AT THE DESIGNATED AREA WHILE WORK IS BEING CARRIED
OUT INSIDE THE VESSEL.
Flammable Gas Monitoring Result: (Permit shall be revoked if > 10% LEL & O2 19.5 / 23.5%)
Date/ Time

% LEL

O2

Date/
Time

% LEL

O2

Date/
Time

% LEL

O2