MV BLUEFIN QUALITY MANUAL - Australian Maritime College

Australian Maritime College
APPENDIX 6.2
PERMITS TO WORK – CONFINED SPACE WORK PERMIT
The contractor or their supervisor is responsible for completing this permit. This permit is valid only for the
date and time specified.
The Manager is responsible for ensuring the permit has been satisfactorily completed prior to the
commencement of work.
When the work is complete or this permit expires, the authorised person for the confined space work must
sign off the permit.
Part A: Authorisation
Permit number: Date:
Authorised person (confined space work supervisor):
Permit validity: Date of entry: / / Time of entry: From: To:
Proposed work to be carried out and location:
Name of person entering confined space:
Name of stand-by person:
Part B: Pre-entry Requirements
Requirements Yes N/A Comment/Action
1 Has a confined space risk assessment been
conducted and a risk control plan documented?
2 Are any mechanical, electrical, pipe, valve or other
isolations required?
For example, pipelines (water, steam or gas),
mechanical or electrical drives, sludges, deposits,
wastes, harmful materials, electrical services,
warning notices, locks and tags fixes to means of
isolation, radiation and mechanical services.
3 Have the levels of ventilation and
oxygen/contaminants been checked?
4 Is ventilation equipment required?
Specify type used.
5 Art toxic gases, solids or liquids present?
Oxygen %
Flammable gases % LEL
Other ppm
Append 6.2 - Confined Space Work Permit.docx 1 of 3
Revised: November 2010