Confined Space Entry Permit - Waterfront Place

Health | SafetyHealth & Safety - Incident Prevention StrategiesHS-IPS 05-05.02Confined Space Entry Permit1. Work DetailsClient/Site/Project:Confined Space Location:Names of Person/s conducting work:Description of Work:Prior to permitting the person(s) intending to perform work in confined spaces, management are to verifythat the person(s) are adequately trained.Standby Person(s)Names:(must be trained in FirstAid and Confined Spaces)2. Hazards and Risk ControlsAtmospheric Testing£ Atmospheric testing completed and satisfactory:– Oxygen, 19.5% to 23.5%– Carbon Monoxide < 30ppm– Concentration of contaminants < 50% ofrelevant exposure standard excluding CarbonMonoxide– H2S levels < 10 ppm£ The atmosphere has been tested, and the testequipment calibrated to ensure no oxygen deficiency orexcess flammability and/or explosive levels are present,and for the following contaminants (less than 5% of theLEL)£ Is continuous air quality monitoring required?£ If Yes, the monitoring has begun prior to entryThe confined space is safe to enter under the followingconditions:£ With an air supplied respiratory protective device£ With an air purifying (non-air supplied) respiratoryprotective device£ Without a respiratory protective deviceWarnings and Barricades£ Warning notices and barricades are positionedappropriately£ Smoking has been prohibited in the confined spaceand surroundsAdditional Risk Controls:Isolation of Energy SourcesThe following have been isolated or made safe:£ Pipelines (water, steam, gas etc.)£ Electrical Services£ Radiation services£ Harmful materials£ Warning notices/locks/tags have been fixed to identify/managethe isolation£ Mechanical/electrical drivesPersonal Protective Equipment (PPE)The following PPE shall be worn by all employees/contractors:£ Supplied-air respirators£ Air purifying respiratory protective devices£ Safety belts, harnesses, and/or safety line or lifeline/rescue line£ Eye protection£ Hand protection£ Feet protection£ Protective clothing£ Hearing protection£ Safety helmetsEmergency Response£ Emergency procedures and equipment are detailed in the riskassessment£ Emergency equipment is maintained in accordance with OEMrequirements£ Emergency equipment is available at all times during entry3. Use of Chemical Agents Authorised for use in the Confined SpaceChemical AgentRemedial Action UndertakenVersion: 1 Date Printed: 28/06/2011 Page: 1 of 2Uncontrolled When Printed

Health | SafetyHealth & Safety - Incident Prevention StrategiesHS-IPS 05-05.02Confined Space Entry Permit4. Hot Work£ Is Hot Work taking place in the confined space?£ If Yes, a Hot Work Permit has been completed,reviewed and signed off?If Yes, the following additional precautions are also tobe undertaken:£ Areas free and clean of combustibles within 15 metres£ All drains within 15 metres covered with a water prooffire blanket£ Appropriate fire extinguishers on site near source(s) ofignition£ Water hose runs to work site and can be turned on at nozzle£ Welding machine earthed directly to equipment being weldedas close to welding point as possible£ All sparks from work more that 2 metres above the groundconfined by an appropriate enclosure, which shall be inspectedbefore beginning work£ Power leads not draped across pipelines or access£ Electrical trace on pipes isolatedAdditional Risk Controls:4. Verification üAll person(s) have received instruction in the Risk Assessment and/or Job Safety Analysis (JSA) forthe work activity.All person(s) understand the potential risks involved in the work to be carried out.All person(s) understand the controls to be implemented.Other, specify.5. AuthorityPerson Issuing Permit:Signature:Permit Valid from:Date:Time:Person Receiving Permit:Signature:Permit Valid to:Date:Time:6: Record of AttendanceName Entering/Leaving Time Date7. Upon Suspension/Completion of Work (please specify)All persons and equipment have been withdrawn from the confined space due to:All persons and equipment have been withdrawn form the confined space as the work has been completed.8. Authority I accept that the work specified above in this permit has been completed.Person who Issued Permit:Signature:Permit who Received Permit:Signature:Date:Time:Date:Time:Version: 1 Date Printed: 28/06/2011 Page: 2 of 2Uncontrolled When Printed