Laying & Construction of Steel Gas Pipeline And

Terminals For North East Gas Grid (NEGG)

Pipeline Project Section-1 Part A & B

CONFINED SPACE WORK PERMIT KPTL/HSE/F-006 Rev.0

Project Site : Sr. No. :

Name of Work : Date :
Name of the Contractor: Nature of Work :
Exact location of work :

Safety requirement:

(A) Has the equipment been?

Y NR
Isolated from power/steam/air
Isolated from liquid or gases
Depressurized &/or Drained
Blanked/ Blinded/Disconnected
(B) Expected Residual Hazards
Lack of O2
Corrosive chemicals
Heat / Steam / Frost
(C)Protection Measures
Gloves
Protective Clothing
Grounded air educator/blower/AC
Fire Fighting Arrangements
Authorization/Renewal(It is safe to enter the confined space)
Date No. of Name of persons
persons allowed
allowed
Y NR Y NR
Water Flushed &/or steamed Radiation sources removed
Man-ways open & Ventilated Proper lighting provided
Cont. inert gas flow arranged
Adequately cooled
Combustible gas/Liquid H2s/Toxic gases
Pyrophoric iron/ scales Electricity / static
High Humidity Ionizing Radiation
Ear plug/ Muff Goggles/Face shield
Dust/gas/airline mask Personal gas Alarm
Attendant with SCBA/air mask Rescue equipment/team
Communication equipment
Signature Time Signature
Contractor’s Contractor’s from To Workman
supervisor Safety officer

Permit Closure :

a) Entry Closed Was Stopped Will Continue on..................

b) Site left in safe condition Housekeeping done.

c) Multilink

Removed Key transferred

d) Ensured all men have come out Man-ways barricaded

Remarks if any:-__________________________________________________________________________________________
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