hime Accese Not PART] “OF PER TION J s2ofr/ iF. DAT AM/ GL] 200 BAR W/ tJ 40 bee) maj on yt oO seat Fe gS rete yak y on 4 20 Q ah 8 a4 j3e3R Cady Bde peak, ee bury te Valin — Hh q Const Daf pi ae Of “in Ure weHS STeL “CoM 2 Seuss of SO" tk Rust — oe Rating / decaying 4 Displacement by Gas * Ke Het Wack. B Tope Verba ee Forad Naducad & Ehwt Pucgn e te Displace ,remevt + aN, Ar Hentem v - ies of bale, ascoh Held enter Fremty & gecbly et go ye Semen uty 4 Gasses 5 Clock. Sym bel ® € wat - (Bime tes] — po - a cee Pl, yey Wich? FINED SPACE Mag eC : 1 ow Kot a “Zero span (Fresh av Zero Span) Og nn Oisencus co Hen pay 2D Too > 07% a set dork Mest Commer CO; He 5, Others CO* Chleonme., Amon ~ Ehale CO* Exhale OF ni 7 Relative Dens Wow hey gas 1s (High Low) Gases Faucher not fem (hey Womans Rah meocdé the highs @ Lows In that space (most used Seren). Mush Revord 24 ante get € en CLEAR LT:Reguludhons = Law ee Notes WS ming mk UM eas 482066: 2009) / ey. Bhrs/day 5 degs/ wk,”Student Notes CopeiwEe 0 SPACE pave‘Student Notes(ea CONFINED SPACE PERMIT Focus Be Safety aa PERMIT NO: THIS PERMITS TO BE KEPT AT THE CONFINED SPACE ENTRY POINT WHILE PEOPLE ARE WORKING IN (OR ON A CONFINED SPACE. Name of Permit Holder: Lee a vate: 27/7, Location of work: chator SP Sime Chon Work Order Number (if available): ne fA of work: Vise. ns peefoo~ @ £ Does the work require specific job experience other than being confined space trained and appointed: YES / If “YES”, describe experience required:‘TRANSFER OF PERMIT: ‘This section is to be completed if the permit is to continue over change of shift or change of Permit Holder. Alll information to be forwarded on to the new permit holder. New permit to be completed when table is full. ‘OLD PERMIT HOLDER | DATE & TIME ‘SIGNATURE NEW PERMIT. DATE & TIME =| SIGNATURE HOLDER 1. WoLaTION WORK AREA NEEDS T0BEISOLATED FROM: water/62s Khemias [TE AutomatcFresytems [az Mechanical / Electrical Dr Yes Hydraulic / Electrical Services Yes sludges / Deposts/weste [ves {0 Radiation Devies ves || Are thereany other energy sources that require lation? | Ys IF "YES", detail what they are: Isolation Lockout Complete? [Yes_[ No 2. CHEMICALS Are chemical agents going to be used within the confined space? _ [Yes feo} NO OTHER CHEMICAL AGENTS OTHER THEN THESE LISTED MAY BE TAKEN INTO THE CONFINED SPACE. Material Safety Data Sheets have been referred to for the chemicals listed above. Yes_[ No JHA identifies hazards and controls for using the chemical in a confined space. Yes_| No3, PERSONAL PROTECTIVE EQUIPMENT MUST BE WORN IF TICKED “YES” Supplied air respiratory equipment (must have General Manager | Yes approval) Air purifying mask /air | Yes Hardhat |(fes ) No hood Cutting / welding Yes Communication equipment co protective eyewear Welding gloves Yes Confined Space harness |(Yes)| No eres ed) Sw | GO| ® Hearing protection Yes 4, ATMOSPHERE - TESTING EQUIPMENT ‘The confined space gas monitor and test equipment is an approved detector / monitor |/VeS |}No The detector / monitor's calibration date is current fas) No Lb The detector / monitor passed the self test / bump test against known sample /[ N/A} Yes | No ake: E/T! moder NYE serialnumber: 0003 pate: “L7/ 7/ (e _|time: 0°90 Confined Space Permit Holder: Signed: 4. ATMOSPHERE ~ INITIAL TESTING Initial testing required (Yes!] No ‘Actual Reading Gas (Outside confined space) (inside confined space) Oxygen 02 % Flammable gases LEL% Carbon Monoxide CO ppm Hydrogen Sulphide HS ppm Other...‘THE ATMOSPHERE IN THE CONFINED SPACE HAS BEEN TESTED. Oxygen 0; % (19.5 - 23.5%) 0; % within spec Yes | No Flammable gases LEL % (less than 5%) LEL% within spec Yes | No Exhaust gases ~CO (less than 30 ppm) CO ppm within spec HS (less than 10 ppm) HS ppm within spec | Yes | No ‘Are there any other gases present? | Yes | No IE'YES", detail what they are: Is the level of the other gases present within specification? Yes | No \s the temperature within the space satisfactory for work to be undertaken? Yes | No Is mechanical ventilation required? Yes | No If ventilation is required then how? (refer to ventilation procedure)ab 5, ATMOSPHERE ~ MONITORING Continuous monitoring required (Yes) No Location of Gas Testing required __| Mins Detector during, every ne Monitoring process Date Time | TESTER (print [0,% |LEL [CO [HS | Readings | SIGNATURE name) % are safe? 27/7/12 |s46em| Joel Bol ol ob. | No | ez b7/7/12z _|$rtem | Fergie V2.8 |o-or| oor |\oxB| Me | ZZ 1/7 11% _|Ps2um | Joed 19.4 |oeloor [Dull ve | KE aap bbw we? | sete los | Ae lagh/i# |e | aver pd bes] 0 Me ey 0 Qo ° Ah 2) Rauf) _|8554m| Engvar _|s7- 3 | A Hu — s2/a)(2 pstem| Stewreyt |lt-7 0 3% | AF 2yel fe Hil | Lock (ns aan | Z |Date Time [TESTER (print | 0,% |UEL [CO [HS | Readings | SIGNATURE name) % are safe? fany reading is unsafe vacate the space. I more space required than attach additional test sheet referencing this permit number. Additional record space at end of permit. Confined Space Permit Holder: Signed:6. AUTHORISATION TO ENTER CONFINED SPACE All persons working on job briefed on work instructions? This confined space is safe for entry to carry out the work described provided all precautions are fully observed? Yer Permit Holder: Signed Oe No No vem tsner name: SOP swt, cE. gechabeeo - ve: 0) } | 7. STAND-BY PERSON ‘STAND-BY PERSON MUST MAINTAIN CONTACT WITH PERSONS IN THE CONFINED SPACE ‘Questions for stand-by person: 1. Rescue procedures understood? 2. Communications in confined space established? Name (print | Time TFNO to either of only) from: the above ‘questions, then confined space work must cease. Yes No Yes No Yes No Yes Wo ves No Yes No Yes No Yes No Yes No TT | ~ Yes No Yes No Yes No8, SIGNING TO ENTER AND LEAVE CONFINED SPACE Note: Personnel must sign “on’” before entering the confined space to confirm they have read this entry permit, Fully understand it and intend to observe the precautions to be taken. Personnel must sign “off” after leaving the confined space. Name of person entering Confined ‘Space (Block Letters) ‘Signature “ON” Date & Time Signature “OFF” Date & Time9, HOT WORK WITHIN A CONFINED SPACE IS HOT WORK GOING TO BE CONDUCTED IN OR ON A CONFINED SPACE? Yes: tae] fyou answer “NO” to any of the following questions and can’t address the issue yourself, you nf stop and seek advice from an RTCA team leader or a Contract Supervisor. This section must be completed for any welding, thermal or oxy cul nal cutting, heating and other fire or spark producing operation in a confined space. By fri 1, Is Hot Work Procedure available and has it been communicated to the work party? _| Yes | No 2. Have hot work hazards been identified and controls put in place to eliminate the Yes | No risks associated with the hazards? 3. When working on a Confined Space have the hazards associated with N/A | Yes | No carrying out Hot Work been fully identified and controls put in place? 4. Do the Automatic Fire Systems need to be isolated? N/A | Yes | No (the supervisor or contract supervisor must be notified if the system is to be isolated) 5.1s a spotter required based on the potential hazards? Yes | No 6. Are all areas within 5 metres of the hot work clean and free of all hazardous and | Yes | No combustible materials? 7. If not possible to remove these materials, has the area been controlled? I.E. cleaned, | Yes | No watered down or covered with fire resistant blankets 8. Is fire protection equipment within range (10m) of the proposed hot work? yes | No 9. Is the fire protection adequate; has it been inspected and ready to use? yes | No 10. Is the work party trained in the use of the fire protection equipment? _ yes | No 11. Is the electrical supply fitted with Earth leakage protection and are voltage-reducing | Yes | No devices fitted where a welding machine open circuit voltage exceeds extra low voltage?_ 12, |s there an electrical supply shutoff device located outside the confined space that _| Yes | No allows the standby person to shut off all electrical supplies into the confined space if required? 13. s the equipment approved for use at the site for the work you are doing? yes | No 14, Have all unnecessary power and gas leads been removed from the immediate hot | Yes | No work area? 15. Are flashbacks arrestors fitted to the oxy cutting equipment (both ends)?__| N/A | Yes | No Yes | No 16. Is the required PPE available and in good working order for the hot work? 17. Will the area need to be monitored after the hot work is completed? (This will depend on the nature of work, combustion materials, and other matters identified in| Yes | No the risk assessment) 18, Are Material Safety Data Sheets available for the welding equipment and materials_| Yes | No being worked on, and possible products of the hot work process?10. OTHER PRECAUTIONS. Warning notices / barricades / No smoking signs in position? ({¥es)| no_| n/a Are all electrical tools to be used double insulated? Yes (No™@N/A Have the alternative use of air tools been considered? Yes [No (7A. Has the working postions for peopl, temperature and humidity hazards been |(f@.| No. | N/A considered? Can the Standby Person see the person/s working in the Confined Space? Yes {fio} | N/A + K+ abode Work instructions or comments: 1 to be used to maintain contact with the person/s working in the confined gachue Yeh 2. won 4 o contnedspce remit tie: sane, (LE 11. SIGN OFF FOR COMPLETION 1. All persons are accounted for and signed off in section 8 Yes | No 2. All equipment is accounted for and in usable state. yes | No 3. All work is complete. Yes | No 4. Ifno, has an out of service tag and isolation officers N/a | Yes | No lock been fitted to the relevant points? 5. Area has been inspected and made safe Yes | No 6. Are all relevant risk assessments attached to this permit Yes | No 7. Are all other related work permits attached to this permit? N/A | Yes | No | 8. Are barricades removed? wa | Yes | No Comments: Completed Permit to be filed. Confined Space Permit Holder: Name: Date:___ signed: