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C.S.E.P Confined Space Entry Permit

For Mittman Marine

Prepared by N.Lambrecht Safety Advisor

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Confinedspace

1. OBJECTIVE

The objective of this standard is to provide guidance for management of and a procedure for safely w011dng with confined ·spaces.

2. REFERENCES

4.

• Mines Safety and Inspection ACf 1994 (Reprint 1996)

• Occupational Heafth and Safety ACf 1984 (Reprint 1996)

• Mines Safety and Inspection Regulations 1995 (Reprint 1997)

• Occupational Safety and Heafth Regulations 1996

• AS 2865-1995 Safe Working in a Confined Space.

DEFINmONS

Authorised Isolator

Atmospheric Testing Person

Competent Person

A competent person authorised by the relevant Department to carry out isolation and de-isolation of equipment.

A competent person authorised to test the quality of the atmosphere.

A person who has, through a combination of training, education and experience, acquired knowledge and skills enabling that person to perfonn correctly a specified task.

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Confined Space

(As per OCcupational

Health and Safety Regulations 1996)

Confined Space Categories

Confined Space ID

Confined Space Entry Permit

Entrant

Entry

An enclosed or partially enclosed space which (a is not intended or designed primarily

as a workplace

(b) is at atmospheric pressure during occupancy;and

(c) has restricted means for entry and exit;

and which either-( d) has an atmosphere which

contains potentially harmful levels of contaminant;

(e) has an unsafe oxygen level;· or (f) is of a nature that could contribute

to a person in the space being overwhelmed by an unsafe atmosphere.

Examples include but are not limited to tanks, process bins, open-topped spaces such as pits or sumps, pump hoppers pipes, sewers, ducts and similar structures.

Qltegory 1: A simpJe confined space entry. The hazards found in this category are of a physical nature only. Potential for atmospheric hazards will not be present.

Category 2: All confined spaces not defined in Category 1. Potential for atmospheric hazards may be present.

The unique identification assigned to a confined space.

The permit that must be completed prior to entry of a confined space.

Any person required to enter the confined space.

A person is considered to have entered a confined space if their

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Job Safety Analysis (JSA)

Owner Supervisor

Shall

Should

Stand-by Person A

upper body or head is within the confined space.

A task involving an entry, an exit and a subsequent and almost immediate re-entry may be regarded as single entry provided no additional hazards are introduced as a consequence.

A process undertaken prior to the commencement of a job in order to identify all the tasks and document the potential hazards, assess the risks and record controls.

A competent employee authorised by the relevant Manager to control an area of responsibiUty.

"shall" is understood as mandatory.

"should" is understood as recommended but not mandatory.

competent person assigned to remain outside of, and in close proximity to, the

confined space and capable of being in continuous communication with and to observe those inside, if practicable. In addition, where necessary, initiate rescue procedures and to operate and monitor equipment used to ensure safety during entry and work in the confined space.

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5. MANAGING CONFINED SPACES

5.1 Responsibilities

The following responsibilities shall be met by those identified.

Department Manager • Ensure a register of confined spaces is maintained. • Ensure appropriate confined space signage is in place and

maintained in good order. • Ensure all personnel required to work with confined spaces,

including contractors, are trained and assessed as competent to perform work in confined spaces.

• Approve in writing, on documented evidence of appropriate training and competency: OWner Supervisors, Authorised Isolators and Atmospheric Testing Personnel.

• Ensure a controlled list of OWner Supervisors, Authorised Isolators and Atmospheric Testing Personnel is maintained.

Owner Supervisor An Owner Supervisor acts on behalf of their Manager to ensure safe execution of the work.

An OWner SUpervisor shall complete the relevant operational procedures, which include issuing the formal Entry Permit prior to aiJowing any person to enter a confined space. Entry Permits are required for all confined spaces.

An Owner Supervisor shall be trained in: • This Confined Space Procedure • Job Safety Analysis Procedure • Legislative requirements for confined spaces • Atmospheric Testing • Emergency Procedures

An Owner Supervisor shall: • Confirm the currency of existing JSA's review and where necessary

review or conduct JSA's prior to entry of the confined space.

• Not allow any confined space entry to commence without a documented JSA.

• Ensure all control measures referenced on the JSA are adhered to.

• Ensure competence of work crew (entrants and stand-by persons) to undertake tasks.

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• Explain to the work crew, and con finn appropriate understanding of all requirements of the JSA, entry pennit and attachments before entry to a confined space.

• Validate confined space entry pennits when they are satisfied that all the necessary precautions have been undertaken to ensure safe entry into the confined space.

• Effectively communicate any relevant hand over matters.

Authorised Isolator An Authorised Isolator acts on behalf of the Owner Supervisor to conduct specific tasks relating to the isolation and de-isolation of equipment. ( eg isolate, prove isolation, place Jocks and tags on equipment)

An Authorised Isolator shall report the results of their specific task directly to the Owner Supervisor.

An Authorised Isolator must have completed training in isolation of hazards; and where isolation requires specific expertise, eg electrical or mechanical trades, or radiation safety, have appropriate fonnal qualifications and experience.

Abnospheric Testing Person An Atmospheric Testing Person acts on behalf of the Owner Supervisor to test the atmosphere of a confined space.

The person is responsible for ensuring test equipment is in good working order and within calibration.

Atmospheric Testing Persons shall be trained and assessed as competent in the use of testing equipment relevant to the confined space and the potential atmospheric conditions.

In addition they shall be familiar with the confined space and it's surrounding areas.

Testing shall occur immediately before and may occur during work in the confined space.

Stand-by Person A stand-by person is a competent person assigned to remain on the outside of, and in close proximity to the confined space.

The person needs to understand the confined space procedure, and as minimum shall be trained and assessed as competent in: • Basic life support.

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• Basic atmospheric testing. • Basic fire fighting skills. • The duties of a stand-by person.

Subject to the JSA requirements, a stand-by person may need to be trained in:

• Use of breathing apparatus. • Basic understanding of emergency response procedures.

A stand-by person shall: • Not enter the confined space (unless it is an emergency situation

and they have suitable back-up procedures in place).

• Place a personal danger tag at the entrance to the confined space when starting duty, and remove the tag when finishing duty.

• Record on the entry Jog the time they start and finish their duty

• Maintain contact with persons in the confined space; (visual if practicable).

• Ensure controls for entry to and exit from the confined space is maintained.

• Assist entrants in ensuring any potentially hazardous materials or equipment does not remain in the space for longer than is necessary to conduct the work (e.g. gas cutting hoses and quantities of hazardous substances).

• Appropriately monitor for and address any situation, which may introduce directly or indirectly hazards into the confined space ( eg the placement of a machine emitting exhaust fumes in close proximity to the confined space entrance or an air intake).

• Operate and monitor equipment used to ensure safety during work in the confined space.

• Ensure availability of any emergency equipment. • Have available and verify an appropriate means of summoning

rescue personnel. • In the case of an emergency, summon rescue personnel and initiate

any actions external to the space (e.g. activate winding mechanisms to withdraw an entrant fonn the space via their harness, or clear an area for access of rescue personnel).

• Initiate an evacuation of the confined space if: --- they can not remain as standby person and no replacement is

available; - a scheduled atmospheric test has not been performed;

- there is a change in conditions that may increase the risk to entrants.

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Entrants Entrants work within and around a confined space under the approval of the Owner Supervisor.

The entrant needs to understand the confined space procedure, and as a minimum, shall be trained and assessed as competent in the duties of an entrant; induding subject to the JSA: • Use of breathing apparatus. • Basic atmospheric testing. • Other specialised equipment.

Entrants shall: • Place a personal danger tag at the entrance of the confined space

before entry, and remove this tag when leaving the space.

• Have recorded their name and time in on the entry log when entering the space and their time out and signature on leaving the space.

• Not enter or remain in the space if the JSA specifies a stand-by person, and there is no stand-by person in attendance.

• Evacuate the space if instructed to do so by the stand-by person.

• Ensure that any potentially hazardous materials or equipment does not remain in the space for longer than is necessary to conduct the work (e.g. gas cutting hoses or quantities of hazardous substances).

• In conjunction with other work crew members, continually consider any possible changes in conditions in the space which may impact on entrants and evacuate if risk factors increase.

Subject to the requirements of the JSA, the entrant may need to: • Wear breathing apparatus. • carry a gas detector. • Undertake a fitness assessment.

5.2 Work aaoss shifts

Whilst work is being undertaken the Owner Supervisor responsible for a confined space entry should be available, therefore at the completion of an Owner Supervisor's shift they will need to appropriately hand over responsibility to the incoming Owner Supervisor. The incoming Owner Supervisor shall sign acknowledgment of the hand over in the shift log.

Similar requirements for appropriate and full hand over as above are

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also applicable for Stand-by-Persons, Entrants and Atmospheric Testers

An Authorised Isolator's isolation remains current across shifts, however if they are not available when de-isolation is required, the Owner Supervisor may have another Authorised Isolator undertake that role for the de-isolation. Full responsibility for the de-isolation will now lay with the involved OWner Supervisor and Authorised Isolator.

5.3 Fitness for Work In A Confined Space

It is recognised that it may not be appropriate for some employees to work in confined spaces. The following guidelines are designed to address this concern.

• The overriding prindple to be applied is that work will be carried out only when it can be done safely.

• Each potential confined space entrant and stand-by person shaJI be trained in the potential hazards associated with working in a confined space.

• As part of the awareness training, each participant will be assisted in undertaking a self-assessment designed to identify potential 'fitness for work' issues that may result in increased risk where work is to be conducted in a confined space.

• The trainer and the participant will confidentially and jointly review the self-assessment to ensure they are fully aware of potential hazards assodated with confined spaces as they may apply to the participant.

When a person becomes aware of the reasonable possibility of being asked to enter a confined space, and they consider they may be at risk from entering or working in that space, it is their duty to advise their supervisor and if appropriate the Owner Supervisor.ke the given

Examples include but are not limited to tanks, process bins, open-topped spaces such as pits or sumps, pump hoppers pipes, sewers, ducts and similar structures.

• Stand-by Person A competent person assigned to remain outside of, and in close proximity to, the .

• The company may refer an employee for medical assessment of their fitness to work in a confined space.

• In the case of contractors being entrants or stand-by persons, it shall be the responsibility of their employer to have considered the

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ongoing fitness and aptitude of their employees for confined space work and their condition on the day the work is to be undertaken.

5.4 Equipment Design and Purchase

5.5

When Sourcing new equipment, or modifying existing equipmene

• As far as practical, ensure the design eliminates the need for entry into a confined space.

• Where it is not practical, ensure the design minimises risk of injury or harm, and that there is a safe means of confined space entry and exit.

Identification, categorisation and Regisbation of Confined Spaces

A system shall be established to uniquely identify and locate each confined space. Where practical, it is recommended that the maintenance system equipment codes be used.

A register shall be maintained with relevant details of the confined space including:

• The confined space unique identification. • Its location. • A brief description. • Any relevant JSA's and Procedures.

5.6 Signage of Confined Spaces

A sign of an appropriate material and size for the location shall be affixed close to each entrance to the space. The sign should follow the guidelines set out in AS 1319; Safety Signs for the Occupational Environment. The confined space identification shall be. clearly marked

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5.7

• File permit for minimum of one month.

The Owner Supervisor should consider any recommendations for improvement of the confined space entry, and where appropriate they shall be entered on the corresponding JSA.

A sign of an appropriate material ~nd size for the location shall be affixed dose to each entrance to the space. The sign should follow the guidelines set out in AS 1319; Safety Signs for the Occupational Environment. The confined space identification shall be clearly marked on the sign, which shall be maintained in good order. It is important the sign be positioned so that it remains visible at the entrance at all times (i.e. not obstructed by open hatchways etc.). An example of a suitable sign is shown below.

CONFINED SPACE

CONFINED SPACE IDENTIFICATION

Black

Signal Red

White

The placement and condition of the signs should be included on general inspection checklists.

Training And Assessment

Training in this procedure, (and re-training at appropriate intervals not exceeding two years) and assessme,nt for competency shall be given to persons who:

• Perform work in or on confined spaces induding stand-by people. • Are Owner Supervisors. • Are authorised to conduct isolations. • Manage and/or supervise persQns working in or near confined

spaces. • Maintain equipment used for confined space entries. • Are involved in rescue and first aid procedures.

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A pennanent record of training shall be maintained.

It is recognised that for certain confined space work it will be necessary for entrants/standby people to receive additional equipment training. The requirements shall be documented during preparation of the associated JSA prior to commencing work.

Where contractors have been engaged to conduct confined space work, evidence of recognised confined space training wilt need to be provided to the relevant supervisor.

Where appropriate rescue procedures shall be planned and rehearsed by emergency services crews.

5.8 Audit And Review

Audit and review processes shall include:

• Annual review of the Department confined space register for currency and accuracy of content.

• Periodic physical checks of the condition of signage, access to the confined space and any associated equipment.

• Review currency of the JSA's each time a pennit is issued. • Fonnal review of associated JSA's whenever plant or process modifications

occur, and at a period not exceeding 5 years.

This procedure shall be reviewed whenever changes to legislation, the relevant Australian Standard, significant change to the scope of activities undertaken by the company, as deemed appropriate by management, or a period not exceeding 5 years.

The fonnal review process shall include regulatory changes, consideration of deviations from the documented practice, failure of the system and areas of potential improvement.

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6. WORKING SAFELY WITH CONFINED SPACES

6.1 Confined Space Enby Pennits

Entry to a confined space shall be by pennit only.

The category of a confined space is detennined by the task, design, risk and the JSA for the work to be conducted in the space.

Category 1 For category 1 confined space entry, a tag style pennit is used. See

appendix 2

category 1 is where the JSA has detennined it to be a simple confined space entry where no potential atmospheric hazards exist. Subject to the JSA requirements, a stand-by person may be required.

Category 2 A category 2 confined space entry uses a more detailed 'log sheet' pennit. See appendix 3

category 2 is where the JSA has detennined atmospheric hazards exist, or where due to the work, there is a potential to change atmospheric conditions. Atmospheric hazards include unsafe oxygen levels, flammable/explosive environments or toxic atmospheres.

Physical hazards may also be present in this category of confined space. (eg: uncontrolled release of product, inadequate lighting, falls/slips/trips, fire, radiation etc)

Control measures for a category 2 confined space are detennined by the JSA and referenced on the category 2 pennit. Typical control measures include:

• Atmospheric testing - results are entered on the pennit. • Ventilation. • Use of low voltage lighting. • Isolation of moving machinery. • Fire extinguisher/fire watch. • Fall arrest. • Communication equipment. • Emergency procedures.

Examples of this category include: • Any potential to emit toxic fumes

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• Welding inside a tank - cause oxygen. deficient atmosphere ( < 19.5o/o Oz)

A stand-by person(s) will be required for category 2 confined space entries.

Permit Records Confined space entry permits shall be kept for a minimum of one month after completion of the task.

6.2 Emergency Preparedness

Before issuing a confined space entry permit, the Owner Supervisor is to determine whether assistance from emergency services may be required.

The Emergency Services personnel in discussion with relevant parties will be responsible for establishing the rescue procedure.

All personnel Involved in the rescue procedure must be familiar with the procedure before the work activity commences.

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6.3 A competent person who is familiar with the confined space and it's surrounding areas shall now conduct atmospheric testing.

If the atmosphere Is satisfactory, proceed to step 6.4.

If the atmosphere proves to be unsatisfactory then, depending on the drcumstances, either continue with step 6.2 {ventilation/purging etc until the atmosphere becomes satisfactory), or rea$e$ the JSA and proposed entry.

6.4 On completion of the isolations and other control measures specified by the JSA, the entry permit may be completed.

Complete the general details of the confined space entry; (confined space number, proposed task description, appropriate JSA number and date/time.)

Section 1 may now be completed. Attachments (apart from the already mentioned JSA and Entry Log Sheet) which need to be added to the entry pennit must be listed here. Attachments may include written rescue procedures, MSDS sheets etc.

Complete sections 2 and 3. The Authorised Isolator now completes all isolations and associated control measures specified in the JSA for the proposed task insk:te the confined space. Once the isolations have been completed, the Authorised Isolator enters their name, department and signature in the appropriate locations.

Complete section 4. The written JSA will specify when a rescue procedure is required. The reference number for this procedure shall be entered in the allocated location. If a procedure is specified, the appropriate equipment and personnel shall be in place before entry commences.

The competent atmospheric testing person should now complete Section 5. They shall enter their name, position and signature in the appropriate locations. The results of their atmospheric tests, and the times these were taken shall be entered accordingly.

Atmospheric testing may be required more than once, incJuding during the task. Hence more than one space is provided for results of atmospheric testing. If additional spaces are required to record atmospheric testing, a separate sheet of paper, in a similar format to section 5 may be used. This document shall be kept with the entry permit at all times, and must be listed in section 1 of the entry permit.

Complete section 6 - Additional requirements to be met. Minor changes from the written JSA are added here. (eg: A localised spill may not be reason to re-write or modify a written JSA. However, minor

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adjustments in control measures or simple reminders may have to be advertised as a result.)

The Owner Supervisor is now required to satisfy themselves that all the necessary precautions have been undertaken to ensure safe entry to the confined space and that all previous sections of the permit have been completed correctly.

The Owner Supervisor shall ensure: • A JSA exists for the spedfic task in that confined space and that the

JSA represented is still current. • All isolations specified by the JSA have been completed. • All specified PPE is in place and in good working order. • All other control measures specified on the corresponding JSA have

been completed. • Atmospheric testing has been competently completed. • If a rescue procedure is required, it is planned and in place. • All requirements of the entry permit, JSA and attachments have

been explained to the work crew and that all entrants and stand-by persons are satisfied that the confined space is safe to enter, have viewed the JSA and any attachments and have signed the entry permit.

• The Authorised Isolator has signed the entry permit.

When all of the above conditions have been met, the Owner Supervisor shall sign the entry permit and enter their name and signature in the 'Issued By' section.

After signing the permit, the Owner Supervisor now enters the period for which the permit shall remain valid.

The entry log sheet shall now be completed. This involves entering any time limit as specified in the corresponding JSA.

Complete section 8. When all entrants and stand-by persons are satisfied the hazards have been controlled and that the confined space is safe to enter, they may enter their name, department and signature in the given columns.

6.5 For the confined space entry to commence: • A copy of the signed entry pennit must be placed on the Permit

Board. • A copy of the corresponding JSA must be placed on Permit Board. • A copy of the entry log sheet must be placed on the Permit Board. • Any other attachments specified in section 1 must be placed on the

Permit Board. • The Permit Board must be placed as close as possible to the

entrance of the confined space.

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• Personal danger tags for all entrants/stand-by persons must be placed on the Permit Board.

• When entering the confined space, entrants must enter their name and time in, on the entry log sheet. When leaving the confined space, these persons must record their time out, sign the entry log sheet and remove their personal danger tag.

• When on duty, stand-by persons must enter their name and time on duty on the entry log sheet. When going off duty, they must record their time of finishing and sign the entry log section and remove their personal danger tag.

The confined space entry must be only be undertaken in strict accordance with the JSA, entry permit and attachments.

6.6 On completion of the task; • All personnel, equipment and materials must be removed from the

confined space. • The space shall be secured/closed ready for authorisation of return

to service. • The entrants/stand-by persons shall return the entry permit, JSA,

entry log sheet and attachments to the Owner Supervisor. • The Owner Supervisor shall close the entry permit by entering the

time and date of completion, their name and signature in section 9 on the entry log sheet.

• File permit for minimum of one month.

The Owner Supervisor should consider any recommendations for improvement of the confined space entry, and where appropriate they shall be entered on the corresponding JSA.

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APPENDIX 1 - CONFINED SPACE ENTRY PROCEDURE

STEP BY STEP INSTRUCTIONS FOR SAFE CONFINED SPACE ENTRY

The following flowchart and description provides a step by step process for safely entering and working in a confined space.

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FLOWCHART FOR SAFE ENTRY OF AND WORK IN A CONFINED SPACE

1.0 A request for work within a confined space

is raised. (Refer ttothe confined space

register)

2.0 Has a Job Safety Analysis

Yes

been completed for the given task in the required confined

space?

4.0 What category is the 3.0 Complete a Job Safety confined space? Analysis for the task and

(Remember the task, design and potential the confined space. inside the space defines the category) (Refer to Job Safety Analysis

Procedure)

6.0 Category 2 confined space entry

5.0 Category 1 confined space entry

6.1 Authorised isolator completes the required

5.1 Authorised Isolator isolations outiined on the completes the required JSA.

isolations outlined on the JSA.

6.2 Complete other control measures outlined

5.2 Complete other on theJSA. control measures outlined

on theJSA. 6.3 Conduct atmospheric

testing. 5.3 Owner Supervisor issues the category f

permit and Entrants sign 6.4 Complete and issue the on. category 2 confmed space

entry permit and entry log.

5.4 Commence the task

6.5 Commence the task

5.5 On completion of task, sign off the tag. Return tag for record 6.6 On of work, sign keeping. off the Return for

record keeping.

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Steps To Be Taken When Entering And Working In Confined Spaces

1.0 The Owner Supervisor receives a request for work to be conducted in a confined

space. The supervisor shall then refer to the departmental confined space register to ascertain the confined space ID.

2.0 A search should then be conducted to ascertain whether a current JSA exists for the proposed task inside the confined space.

If the answer is Yes, go to 4.0. If the answer is No, go to 3.0.

3.0 Personnel involved in the confined space entry (eg: Owner Supervisor, Authorised Isolator, stand-by person, entrants, safety personnel) should complete a JSA for the proposed task,

4.0 The category of confined space should then be determined. Confirm the JSA is current. If the JSA identifies design hazards, atmospheric hazards, or potential atmospheric hazards, the confined space shall be dassed as category 2. If there are no known atmospheric hazards and no potential atmospheric hazards, the confined space shall be classed as category 1.

If category 1, go to 5.0 If category 2, go to 6.0

Category 1 5.0 The confined space entry has been classified as category 1.

5.1 The Authorised Isolator now completes all required isolations. The JSA will stipulate which isolations are required for the proposed task. Once the isolations have been completed, the Authorised Isolator proves all isolations. The general details of the confined space entry shall be completed; (confined space number, proposed task description, appropriate JSA number). The Authorised Isolator signs 'Isolations Completed' on the category 1 confined space entry permit.

5.2 All other control measures stipuJated by the JSA must now be undertaken. The control measures must be completed without entering the confined space.

5.3 The Owner Supervisor is now required to satisfy themselves that all the necessary precautions have been undertaken to ensure safe entry to the confined space.

The Owner Supervisor shall ensure:

• A JSA exists for the specific task. in that confined space and that the JSA represented is still current.

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5.4

• All physical hazards identified in the JSA have been controlled (eg: inadequate lighting, obstacles to the entrance, moving machinery in the immedi~e vidnity of the confined space)

• All isolations specified by the JSA have been completed. • AJI specified PPE is appropriate, in place and in good working order. • If a rescue procedure is required, it is planned, in place, or on

stand-by as specified in the JSA. • All requirements of the entry permit, JSA and attachments have

been explained to the work crew and that all entrants and stand-by persons are satisfied that the confined space is safe to enter, have viewed tfte JSA and any attachments.

• The Authorised Isol~tor has signed the entry permit.

The Owner Supervisor shall complete 'Checklist prior to entry'.

When all of the above conditions have been met, the Owner Supervisor shall sign the entry pennit and enter their name and signature in the 'Issued By' section.

When all entrants and stand-by persons (if required) are satisfied the hazards have been controlled and the confined space is safe to enter, they shall sign on the respective Entrants and Stand-by persons Signature line.

For confined space entry to commence:

• The entry permit tag must be displayed close to the entrance of the confined space.

• Personal danger tags of all entrants/stand-by persons must also be placed near the entry permit tag.

• Any person entering the confined space must enter their name and time in, on the entry log section on the entry permit tag. When leaving the confined space, these persons must record their time out and sign the entry log section.

The confined space entry must only be undertaken in strict accordance with the entry permit, JSA and attachments.

5.5 On completion of the task: • all personnel, equipment and materials must be removed from the

confined space. • The space shall be secured/dosed ready for authorisation of return

to service. • The entrants/stand-by persons shall return the entry permit tag to

the Owner Supervisor. • The Owner Supervisor shall dose the entry permit by means of

entering their name and signature in the On Completion of Work section of the permit. ·

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APPENDIX 4- CATEGORY 2 CONFINED SPACE ENTRY LOG SHEET

• The designated number of stand-by persons shan be present prior to entry to this confined space.

• The conditions of entry outlined in the permit, JSA and attachments shall be read and understood by an stand-by persons and entrants.

• All stand-by persons and entrants shall complete the entry log. The time limit for working in this space is: o (As per JSA requirements)

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ENTRANTS NAME TIME IN TIME SIGNATURE

OUT

STAND-BY PERSONS NAME TIME ON TIME OFF SIGNATURE

DUTY DUTY

Section 9 - On Completion of Task

One Shift

• . {hrs:mins)

OTHER

OTHER

The work authorised by this permit, JSA and attachments is complete and aU persons, equipment and materials have been withdrawn from the confined space.

Name Signature Date/time Permit cancelled By: I I . .

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APPENDIX 3- CATEGORY 2 CONFINED SPACE ENTRY PERMIT Con Space No: l JSA No: Task Description:

Section 1-List of attachments

Section 2 -Isolations All isolations and associated control measures required by this permit, the referenced JSA and attachments have been conducted and checked.

! Name l Signature Isolated By: Section 3 - Confirm the control measures referenced on the accompanying Yes JSA, have been met. Section 4- Rescue Procedure Is a rescue procedure required? Yes No Rescue Procedure No: Is it in place? Yes No

Section 5 - At Testing Conducted by: . . . . .

(time) (time) (time) (time)

Name: Oxygen {19.5 -23.5o/o 0 2)

Position: l.E.L. ( <5°/o) Signature: H2S

co Toxic

Section 6 - Additional requirements to be met.

Section 7 - Pennit Issue The confined space, in my opinion, is in a safe coodition foc the described wad< to be uridertakeeen, provided aU

utions noted on this it and attachments are ful observed.

Issued B :

This permit is valid from:

Section 8- Work crew members

Name

• :

Signature

. : As a member of this wori< crew, I understand the requirements for this job, (given in this permit, JSA and attachments), and will comply with my duties as a stand-by VCJ;)UII or entrant.

Name Deparbnent Signature

If more space Is required, work crew members are to fill In their details on the Confined Space Entry Log sheet.

Note: A copy of this permit must be retained at the work site.

FM 002 Workplace Risk Analysis and Control (WRAC) JSA#:

Task Name /Test Method/ SOP Number:: ... ............... ........... ... . . (circle appropriate response)

1 STEP IN OPERATION

(NOTE: reference the Clet.J6e number in the document if applical>le)

2 POTENTIAL RISKS

(NOTE: use abbreviations in legend below to simplify form)

3

WRAC Performed by: Date Completed:

4 5

Page of

WRAC Reviewed : Date Completed:

6 CURRENT CONTROLS

7 RECOMMENDED CONTROLS

- ................ ................. ..... ........................ ..................... ........ ........ . .............. .. ............. ........... _ ..... _ .. , ........... . ........... - ..... .................................. .... ...... .... ....... ......... - ................... ................. .. _ ...................

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LEGEND OF AQBREVIATIONS COLUMN 3: PROPABIUTY 58 - struck by CBT - caught between FLF - foot level fan A- exPected to occur in most circumstances SA. struck against CB- contact by FB - fall to below a. probably to occur in most circumstances CO • caught on CW - contact with OE • over exertion C- should occur at some time Cl - caught in C • cut E - exposure D- could occur at some time SO -$J))sshed on 8 • bum EL - electrocute E- May occur in exceptional circumstances

COLUMN 4: CONSEQUENCE 1- No injuries 2- First Aid Treatment 3- Medical Treatment 4- Extensive Injuries 5- Death

COLUMN S: RISK RANKING I 1 t 2 I 3 I 4 I 5 I I A s s H H H H - High risk B I MIS IS I H I H c I L IM IS I H I H D I L I LIM IS I H E I L I LIM ISIS

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S ·Significant risk M - Moderate risk L- Low risk

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HEIRARCHY OF CONTROL ELIMINATE- get rid of completely SUBSTITUTE • substitUte ENGINEER- modify at source, enclose, move etc AOMINISTRA TE - policy and or procedures PERSONAL PROTECTIVE EQUIPMENT