Document No:

AKYEM OPERATIONS Version No:

Form Issue Date:

Page No:

Confined Space Entry Permit

IN CASE OF EMERGENCY CALL: Land line No 52911, Cell No 0248 236 541, RADIO EMERGENCY BUTTON.
Name of testing equipment being used: Equipment Location:
Permit Issued to
Confined Space to be entered
Reason(s) for entry into Confined Space
Description of work to be performed
Note: Employees who work in confined spaces shall be adequately trained. Such training should include understanding of the hazards involved,
entry and exit procedures, safety equipment, emergency first aid, control measures such as ventilation, use of appropriate respirators if
required, and proper work practices.
Note: This permit expires at completion of the work or when a shift change occurs and a new work crew arrives to complete the work.

PREPARATION YES NO AUTHORISED ENTRANT Sign IN Sign OUT

Has the space been properly ventilated and cooled?
Has all equipment been locked and tagged?
Have pipelines been blinded or locked out and tagged?
Has the space been washed free of chemicals?
Have nuclear sources been locked out and tagged?
Will hot work be conducted within the space?

EQUIPMENT AND CONDITIONS YES NO

Has a JHA been completed?
Has an adequately trained attendant been assigned?
Has attendant adequate means of communication?
Are appropriate electrical tool(s) being used?
Has a safe means of entry/exit been established?
Is there adequate lighting in the space?
Are harnesses and taglines required by entrants?
Is appropriate PPE available?
Can weather conditions affect the space?
Is the mine rescue team required to be present?
Is ongoing atmospheric monitoring required?
If atmospheric monitoring is required, what duration? Hrs

ATMOSPHERIC TESTING
Atmospheric Condition Permissible Limit Initial Reading
Oxygen 19.5 to 21.5
< 5 PPM (<10ppm
HCN wit Respirator)
CO2 < 50 PPM
CO < 25 PPM
Nuclear Source < 6m R/hr
WBGT Temperature (T) < 40oC
LEL (CH4) < 10%

PERMIT APPROVAL
Name Sign Date Time
Supervisor Authorising Entry
Attendant/Sentry
Contractor Supervisor (if required)
PERMIT CLOSURE
Supervisor Authorising Closure
Attendant/Sentry
Contractor Supervisor (if required)

Author: To Be Reviewed:
Approved by: Print Date:
The latest version of this document is available on the Ghana Gold Net as a “read only” file
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