Space Entry Permit

GENERAL
Location/name of enclosed space
Reason for entry ……………………………………………………………………………………………………

from:_________hrs	Date:___________
to:___________hrs	Date:___________

(See note 1)

Section 1 – PRE-ENTRY PREPARATION (to be checked by the master or nominated responsible person)	Yes	-No-
Has the space been thoroughly ventilated by mechanical means?
Has the space been segregated by blanking off or isolating all connecting pipelines or valves and electrical power/equipment?
Has the space been cleaned where necessary?
Has the space been tested and found safe for entry? (See note 2)
Pre-entry atmosphere test readings: – oxygen ………………. % vol (21%)** – hydrocarbon ……….. % LFL (less than 1%) – toxic gases …………. ppm (less than 50% OEL of the specific gas) (See note 3)	By: Time:
Have arrangements been made for frequent atmosphere checks to be made while the space is occupied and after work breaks?
Have arrangements been made for the space to be continuously ventilated throughout the period of occupation and during work breaks?
Are access and illumination adequate?
Is rescue and resuscitation equipment available for immediate use by the entrance to the space?
Has an attendant been designated to be in constant attendance at the entrance to the space?
Has the officer of the watch (bridge, engine-room, cargo control room) been advised of the planned entry?
Has a system of communication between all parties been tested and emergency signals agreed?
Are emergency and evacuation procedures established and understood by all personnel involved with the enclosed space entry?
Is all equipment used in good working condition and inspected prior to entry?
Are personnel properly clothed and equipped?

* It should be noted that this is a generic entry permit that may be used for all enclosed spaces on board all ships.
** Note that National requirements may determine the safe atmosphere range.

SECTION 2 – PRE-ENTRY CHECKS (To be checked by each person entering the space)	-Yes-	-No-
I have received instructions or permission from the master or nominated responsible person to enter the enclosed space
Section 1 of this permit has been satisfactorily completed by the master or nominated responsible person
I have agreed and understand the communication procedures
I have agreed upon a reporting interval of …………. minutes
Emergency and evacuation procedures have been agreed and are understood
I am aware that the space must be vacated immediately in the event of ventilation failure or if atmosphere tests show a change from agreed safe criteria
SECTION 3 BREATHING APPARATUS & OTHER EQUIPMENT (To be checked jointly by the master or nominated responsible person and the person who is to enter the space)
Those entering the space are familiar with any breathing apparatus to be used
The breathing apparatus has been tested as follows: – gauge and capacity of air supply – low pressure audible alarm if fitted – face mask – under positive pressure and not leaking
The means of communication has been tested and emergency signals agreed
All personnel entering the space have been provided with rescue harnesses and, where practicable, lifelines

SECTION 4 – PERSONNEL ENTRY (To be completed by the responsible person supervising entry)
Names	Time in	Time out

SECTION 5 – COMPLETION OF JOB
Job completed	Date________	Time________
Space secured against entry
The officer of the watch has been duly informed

Signed upon completion of sections 4 and 5 by:
Responsible person supervising entry: ……………………………………… Date ………………. Time ……………

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

Notes
	1	The permit should contain a clear indication as to its maximum period of validity.
	2	In order to obtain a representative cross-section of the space’s atmosphere, samples should be taken from several levels and through as many openings as possible. Ventilation should be stopped for about 10 minutes before the pre-entry atmosphere tests are taken.
	3	Tests for specific toxic contaminants, such as benzene or hydrogen sulphide, should be undertaken depending on the nature of the previous contents of the space.