Confined Space Entry Permit - Waterfront Place

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 Upon Suspension/Completion of Work (please specify)All persons and equipment have been withdrawn from the confined space due to:All persons and equipment have been withdrawn form the confined space as the work has been completed.8.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