SWP 02 ENTRY INTO ENCLOSED

SPACE PERMIT

ENTRY INTO ENCLOSED SPACE PERMIT

This check list must be completed by the Responsible Officer and approved / verified by the MASTER prior to execution of entry. If any of the listed conditions change, then
this permit will be invalid and a new permit shall be issued before work continues.

VESSEL : M/T
Location / Name of enclosed space
Reason for entry
Each entry permit should NOT exceed continously 8 HOURS in a day
This permit is valid From: hrs Date

To: hrs Date (See Note 1)

SECTION 1 - Pre-Entry Preparations (To be checked by the Master or Responsible Officer)

ALL QUESTIONS MUST BE ANSWERED TO PROCEED YES NO N/A
1 Has a risk assessment been carried out as per SQEMS Manual Section 9?
2 Does the job involve any electrical work? NOTE: If Yes, the proper Electrical Maintenance Work Permit must be completed and authorized.
3 Does the job involve any hot work? NOTE: If Yes, the proper Hot Work Permit must be completed and authorized.
4 Does the job involve any working aloft? NOTE: If Yes, the proper Working Aloft Permit must be completed and authorized.
5 Does the job involve any lock out / tag out? NOTE: If Yes, the proper Lock Out / Tag Out Permit must be completed and authorized.
6 Has the space been segregated by blanking off or isolating all connecting pipelines including HC and toxic liquid / gas ?
7 Have valves on the pipelines serving the space been secured to prevent their accidental opening?
8 Has the space been cleaned (additionally washed and gas freed if it is a cargo tank) and thoroughly ventilated?
9 Have the atmosphere monitoring equipment been calibrated, tested and found satisfactory prior to testing the atmosphere?
10 Pre-entry atmosphere tests: (See Note 2)
Name of the last cargo (if applicable):
READINGS
Hydrocarbon Oxygen Toxic Gases / H2S
(If the space is adjacent to a Cargo or Bunker Tank)
LEL % % vol H 2S ppm CO ppm Others (if app) ppm
(Less than 1%) (21 %) (Max 5 ppm) (Max 25 ppm) (Specify gas & TLV)
11 Have arrangements been made for frequent atmosphere checks to be made while the space is occupied and after work breaks? (See Note 3)
12 Have arrangements been made for the space to be continously ventilated thoroughout the period of occupation and during work breaks?
13 Is adequate illumination provided?
14 Is rescue and resuscitation equipment available at the entrance of the space for immediate use?
15 Has a responsible person been designated to stand by at the entrance of the space, in direct contact with the Responsible Officer?
16 Has the officer of the watch (bridge, engine room, CCR) been advised for the planned entry?
17 Has a system of communication between the person at the entrance and those entering the space been agreed and tested?
18 Are emergency and evacuation procedures established and understood?
19 Is there a system for recording who is in the space?
20 Have all the appropriate tools, PPE items, SCBA, rescue harness, lifelines and safety torch been provided? Are they of an approved type?
21 Has at least the Team Leader been provided with personal gas detector?
PROTECTIVE EQUIPMENT
Clothing Gloves Fire extinguisher Eye protection Personal gas detector
Safety harness Hard hat Fire hose Hearing protection UHF radio
Safety lifeline Safety boots Resuscitator SCBA Safety torch
Safety belt Safety glasses Stretcher EEBD Others
22 In case of extensive work is considered in a cargo or ballast tank, is the Team Leader enter the tank to make ADDITIONAL atmosphere checking

TEAM LEADER ENTRY TIME EXIT TIME

HC O2 H2S CO Others (if app) ppm
...................................
............................... ........................ ........................ .................. ..................
REA .................. .................. ...........................................
(LEL %) (%21) (max 5 ppm) (max 25 ppm) (Specify gas & TLV)

SECTION 2 - Pre-entry Checks (To be checked by the person authorized as leader of the team entering the space) YES NO N/A
1 Section 1 of this permit has been completely and properly filled out.
2 I am aware that the space must be vacated immideately in the event of ventilation failure or if atmosphere tests change from agreed safe criteria.
3 I have agreed upon communications procedures.
4 I have agreed upon a reporting interval of minutes. ( SHOULD not exceed five (5) minutes )
5 Emergency and evacuation procedures have been agreed and are understood.
Revision: 01.July.2022 Approved by MD Page 1 OF 1
 SWP 02 ENTRY INTO ENCLOSED
SPACE PERMIT

IF ANY CHECK MARKS MUST BE PLACED IN THE SHADED AREAS, THEN THIS ITEM MUST BE RECTIFIED BEFORE PROCEEDING

Revision: 01.July.2022 Approved by MD Page 1 OF 1

 SWP 02 ENTRY INTO ENCLOSED
SPACE PERMIT

ENTRY INTO ENCLOSED SPACE PERMIT

This check list relates to control of enclosed spaces as described in SMS MANUAL which must be completed prior to entry into enclosed spaces.

VESSEL : M/T

Signed upon completion of Sections 1 and 2 by:

Authorised team leader : Date : Time :
(Name & Signature)

The Responsible Officer : Date : Time :

(Name & Signature)

Verification / Approval by MASTER : Date : Time :

SECTION 3 - Checks & records immediately before / during entry (To be carried out by the Responsible Officer)

1. Personnel Entry Log

NAME & SURNAME RANK ENTRY TIME EXIT TIME NAME & SURNAME RANK ENTRY TIME EXIT TIME

2. Periodical Atmosphere Test Results

Time LEL% O2 (%) TOXIC (ppm) Checked by Signed Time LEL% O2 (%) TOXIC (ppm) Checked by Signed

3. State of Readiness - CONTINUITY

Have the ventilation, illumination and radio contact well in place and the protective equipment are in continous state of readiness?
CHECK TIME √ SIGNATURE CHECK TIME √ SIGNATURE CHECK TIME √ SIGNATURE CHECK TIME √ SIGNATURE

SECTION 4 - Completion of Job / Cancellation of Permit

Entry has been completed / cancelled and all members of the entry team evacuated the enclosed space together with their equipment.

Team Leader : Date : Time :

(Name & Signature)

Responsible Officer : Date : Time :

(Name & Signature)
Notes :
1. The Entry Permit should contain a clear indication as to its maximum period of validity which, in any event, should not exceed a normal working day.
2. In order to obtain a representative cross-section of the compartment´s atmosphere, samples should be taken from several depths and through as many
openings as possible. Ventilation should be stopped for about 10 minutes before the pre-entry atmosphere tests are taken.

3. The Responsible Officer should re-test the atmosphere after each break in work periods
4. Means of "Ventilation" : An adequate supply of FORCED air.
5. A copy of this permit should be prominently displayed at the entrance of the space

THE PERMIT IS RENDERED INVALID SHOULD VENTILATION OF THE SPACE STOP OR IF ANY
OF THE CONDITIONS NOTED IN THE CHECK LIST CHANGE

Revision: 01.July.2022 Approved by MD Page 1 OF 1