Confined Space Entry Permit Rev 1
3
Confined Space Entry Permit (CSEP) Location Work Site: __________________________________________________________________________ Purpose of Entry:_____________________________________________ Date/Time:___________________ Person in Charge of Work:______________________________________ Expiration:___________________ Supervisor in charge of crew No of crew Contact No. Special Requirements Yes No Ye s No Can this Space be impacted on from other work areas nearby? Hazardous Material Used? Is signage and/or barriers required to delineate work site? Emergency Rescue Equipment? Is atmosphere testing Required? Exit route defined? Ventilation type Natural Negative Positive Fire Extinguishers Rescuers for Emergency Exit required? Protective Clothing Communication Method Verbal Radio Hand signal PABX Others Respirator Isolation required /Carried Out? De-Energize / Close/Stop/Open Lighting Atmosphe re Testing Tests to be taken Range Initial Date Time Remarks CSEP No :____________ PTW No :____________
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Transcript of Confined Space Entry Permit Rev 1
Confined Space Entry Permit (CSEP)
Location Work Site: __________________________________________________________________________
Purpose of Entry:_____________________________________________ Date/Time:___________________
Person in Charge of Work:______________________________________ Expiration:___________________
Supervisor in charge of crew No of crew Contact No.
Special Requirements Yes No Yes No
Can this Space be impacted on from other work areas nearby?
Hazardous Material Used?
Is signage and/or barriers required to delineate work site?
Emergency Rescue Equipment?
Is atmosphere testing Required? Exit route defined?
Ventilation type
Natural Negative Positive
Fire Extinguishers
Rescuers for Emergency Exit required? Protective Clothing
Communication Method
Verbal Radio Hand signal
PABX Others
Respirator
Isolation required /Carried Out?
De-Energize / Close/Stop/Open
Lighting
Atmosphere Testing
Tests to be taken Range Initial
Reading
Date Time RemarksOK / NO/NA
% of Oxygen 19.% 21.5%
% of L.F.L. Any % Over 10
Carbon Monoxide <50 ppm
Toxics
Organic Dust/Vapor
Name & Signature of Authorised Gas Tester (AGT) : _______________________________________
ISSUE
CSEP No :____________
PTW No :____________
Authorised Person Signature/Name
Date:_____________ Time:_______
Competent Person Signature/Name
Date:________________ Time:_____________
CANCELLATION
Competent Person Signature/Name
Date:___________ Time:_________
Authorised Person Signature/Name
Date:___________ Time:_________
EXTENSION OF PERMIT (for longer than one shift)
Extension is not granted
Approval is granted for permit extension as below:
Date Night Shift SSCE Sign. Day Shift SSCE Sign. Eve Shift SSCE Sign.
THIS WORK PERMIT MUST BE DISPLAYED AT THE DESIGNATED AREA WHILE WORK IS BEING CARRIED OUT INSIDE THE VESSEL.
Flammable Gas Monitoring Result: (Permit shall be revoked if > 10% LEL & O2 19.5 / 23.5%)
Date/ Time % LEL O2Date/ Time
% LEL O2Date/ Time
% LEL O2
