中国石化集团国际石油工程有限公司巴基斯坦分公司

Sinopec International Petroleum Service Corporation Pakistan Branch

CONFINED SPACE ENTRY 进入限制空间

Rig: Well: Date:
To be completed prior to enter into a confined space or commencement of confined space.在开始或进入限制空间前，须完成下
面的填写。

Work permit No.工作许可号

Purpose of permit (check appropriate items)许可的目的（对相关项目进行检查）

Confined Space Entry 进入限制空间 Confined Space 被限制的空间

VALIDITY 有效性
Permit validity is for one tour only.该许可只允许使用一次。

Time issued:发布时间 Time Expired:截止时间

Time:时间 Time:时间
From From
GAS DETECTOR 瓦斯探测器
Instrument Name:工具名称 Model: 型号

Calibrated?: 校对 Function Tested?: 功能测试

Designated and authorized person to conduct atmospheric tests:专业授权人士对大气的测试

Name:姓名 Position:职务 Signature:签字

TESTING 测试
Maximum period between tests is every hours.最多每_____小时进行测试

Test Result 测试结果

Tank or work area Safe for workers 工人的安全 Safe for Hot Work 热工作的安全 Oxygen Reading
(Identify) Yes 是 Yes 是 氧气读数
油罐区域 No 否 No 否 %

H2S Reading 硫化氢读数 CO2 Reading 二氧化碳读数 Other toxic vapor reading Visual Inspection 视察
其它有害水汽读数 Ok
ppm ppm No

* Required Atmospheric Conditions 对空气状况的要求

- Oxygen Content to be 20.8% by volume (19.5% oxygen deficient 23.5% enriched).
- Flammable gas content to be 0% LEL (10% LEL is highly flammable, adjacent spaces must be below 10% LEL according
to OSHA to commence hot work).
- Toxic gas content to be ½ or less of accepted TLV or PEL (whichever is lower) ½ of PEL for H2S 5 ppm ½ of PEL for CO
= 13 ppm.

复查时间 氧气读数 可燃气体读数 硫化氢读数 一氧化碳 其它有害水汽读数

Retest Time Oxygen Reading Combustible Gas Reading H2S Reading CO Reading Other Toxic Vapor Reading
: hrs % % LEL PPM PPM
: hrs % % LEL PPM PPM
: hrs % % LEL PPM PPM
: hrs % % LEL PPM PPM
: hrs % % LEL PPM PPM

MANDATORY SAFETY MEASURES 强制安全措施

Forced Air Ventilation 强制通风 ______ Ladders / Scaffolding 梯子，脚手架 ______
Body Harness 安全带 ______ AntiFall/Rescue Equipment 防坠营救设备______
Explosion Proof Lamps 防爆灯 ______ Emergency Observer at Entrance ______

OPTIONAL SAFETY MEASURES 选项安全措施

Respiratory Protection 口罩面罩 ______
Fire Watchman / Fire Extinguisher 看火人/灭火器 ______
Hearing Protection 耳塞 ______
Personal Protective Equipment (Specify)个人保护装备 _____________
Communication Devices 通讯设备