Permit to Work Major Hazard Standard - MIRMgate

WMC EHS Management System Major Hazard Standard
Permit to Work
APPENDIX E5
E5 CONFINED SPACE WORK AUTHORISATION TAG
FRONT
REAR
No:
Confined Space Inspection
Work Authorisation
Use of this authority is restricted to inspection only
and in compliance with the attached THA/SWP and
Confined Space hazard identification and evaluation
Confined Space ID No:
THA/SWP No:
Entrant Name:
Date:
Time In:
Time Out:
Authorised Person:
On completion of work
Confined Space Inspection
Work Authorisation
Checklist prior to work
Confined Space Register
confirms use of the Tag
Can the inspection be achieved
by head & should entry only?
Hazard Controls in place as per
THA/SWP?
Yes
The inspection is completed, I have left the space,
the confined space is clear of all tools and
equipment.
Entrants Name
Name:
Signature:
Time:
Confined space isolated from all
energies?
Confined Space Inspection
No:
Work Authorisation
Completion of Work
Confined Space Inspection in Progress
Confined Space ID No: Job Completion Time: Date:
THA/SWP No:
All persons & equipment are
clear of the space.
Authorised Entrant
Authorised Person:
Name:
Job Start Time: Date: Time:
WMC-EHS-MHS-007 DocsOpen Ref : 155520 Issued: 23/12/03 Page 40 of 59