Copy of final Checklist and permits 2012.xlsx - MARG Group

DOC.No:MARG/EPC/EHS/F-
01-003
Rev.No:001 Dated:12/12/11
Project Name:
Location:
Name of the permit initiator:
Signature of initiator:
MARG LTD.
PERMIT-CONFINED SPACE ENTRY
Purpose of Entry:
Designation:
Date and Time of applied / Initiated:
Permit No.
Control measures and precautions necessary checklist (by EHS-Represenatative)
S.No.
Description / Requirments
YES NO N/A Remarks
1
2
3
4
5
Has a confined space risk assessment been conducted and a risk control plan
documented?
Have the levels of ventilation and oxygen /contaminants been checked? Record
the readings.
Safe access/egress for operatives available.
Operatives adequately trained and suitable for tasks and trained in use of any
PPE that has to be worn
Incoming services isolated – (*delete as appropriate)
gas*/electricity*/steam*/water*/fuel*/other*
6
7
8
9
Potential ingress of fumes or other substances (e.g. excess rainwater if outside)
has been evaluated and control measures arranged
There are proven means and trained people prepared for evacuating a casualty
from this confined space
Suitable means of communication have been set up for those in the confined
space to persons on watch or outside at all times
Low voltage tools and equipment have been selected, and intrinsically safe
electrical appliances if a flammable atmosphere may exist
10
Adequate ventilation by natural air flow*/mechanical means* has been arranged
(*delete as appropriate) and it is sufficient.
11 Adequate lighting has been arranged
12
Fire prevention arrangements*/fire extinguishers* are provided (*delete as
appropriate)
13 Competent supervision on hand throughout the job
14 Man log & material log has been checked and found ok?
Conditions of permit issuuing
The above work is authorized to proceed subject to the above inspections and below mentioned conditions being taken and maintained
during and after of the work. Always one rescue marshal (with first aider) should be standby to vigil at the above place. the work area
and adjoining areas must be inspected by the permit acceptor from start of work until 30 minites after completion of work (including
break / rest period)
I declare that the above listed inspections has been carried out by me and I consider that the above mentioned area to be safe for
commencement of work.
Date:
Permit commences & Permit expires
Name of the Permit Issuer (EHS Representative):
Sign of issuer:
Time: to Date & Time:
Additional commands : (to be filled by EHS-Officer)

PPE REQUIRMENT AND USAGE
Permit Acceptor (Site Engineer):
Sign of Acceptor:
Date & Time:
I hereby authorise the work specified
above to continue until the time stated
below and that I have checked the safety
arrangements and confirm that they
remain adequate.
Permit Issuer (EHS Representative):
Name:
Permit Acceptor (Site Engineer):
Name:
Permit Acceptence
I understand the conditions of permit and the safety precautions that are necessary to complete the work safely as outlined in the
appropriate HIRA Manual: MCL/EPC/HIRA001/2011 dated on 20110523. Also I assure that i will maintain & comply the above
mentioned Inspections and conditions during entire course of work and i will explain the same to all concerned workers to
understand the requirements.
Continuation of Work
I have checked the safety arrangements and I am satisfied and agree to
accept responsibility to complete the specified work by the revised time
Sign of issuer:
Date & Time:
Reason for cancellation:
Sign of Acceptor:
Date & Time:
Permit Cancellation(During work)
Permit Issuer (HSE Representative):
Sign of issuer:
Date & Time:
Cancellation of work permit (after complition of work)
I declare that the work described above is
complete all work equipment, persons and
materials under my control have been
withdrawn. All safeguards have been
reinstated and the work area returned to a
safe status and service.
I declare that the permit is now closed and I have received copies of the permit back
from the Competent Person. The area has been inspected and is free from risk and all
fire protection systems have been reinstated to their normal operating status.
Permit Acceptor (Site Engineer):
Sign of Acceptor:
Permit (EHS Representative) Issuer:
Sign of issuer
Date & Time:
Date & Time:
The permit will become invalid or the permit cannot be issued by permit issuer, if the serial nos2, 3,4,5,7,10 &13 are not satisfied of
the inspections area.