Person entering the space, or if more than

one, the team leader If there is more than one person entering the space then one person shall be nominated as the leader and he is responsible for completing these sections.

General

Location/Name of enclosed space.................................................................................

(One permit is to be completed for each enclosed space)

Reason for entry............................................................................................................

This permit is valid From:..........hr Date................................. To:..........hr Date.................................

(See note 1)

Section 1 - Pre-entry preparation (To be jointly completed by the Master or nominated officer in charge and the responsible person supervising the entry)

Yes No

· Have valves on all pipelines serving the space been secured o o

to prevent their accidental opening?

· Has the space been thoroughly ventilated? o o

· Has the space been segregated by blanking off or

isolating all connecting pipelines or valves and

electrical power/equipment? o o

· Has the space been cleaned where necessary? o o

· Has the space been tested and found safe for entry? o o

· Pre-entry atmosphere test readings: (See note 2)

- oxygen......................% vol. (21%) Tested By......................

- hydrocarbon.............% LFL (less than 1%)

- toxic gases...............ppm Time:......................

- specify above toxic gas and PEL ………………………………….…..

(See note 3)

· Have arrangements been made for frequent atmosphere checks

to be made while the space is occupied and after work breaks? o o

· Have arrangements been made for the space to be o o

continuously ventilated throughout the period of

occupation and during work breaks?

· Is access and illumination adequate? o o

· Is rescue and resuscitation equipment available

for immediate use by the entrance to the space? o o

· Has a responsible person been designated to be in constant

attendance at the entrance to the space to supervise the entry o o

Name ……………………………………..

· Has the officer of the watch (bridge, engine room, cargo

control room) been advised of the planned entry? o o

· Has a system of communication between all parties been

tested and emergency signals agreed? o o

· Are emergency and evacuation procedures established and

understood by all personnel involved with the enclosed

space entry? o o

· Is all equipment used in good working condition and

inspected prior to entry? o o

· Are personnel properly clothed and equipped? o o

Section 2 - Pre-entry checks (To be completed by the person entering the space or, if more than one, the nominated team leader )

Yes No

· I have received instructions or permission from the master

or nominated responsible person to enter the enclosed space o o

· Section 1 of this permit has been satisfactorily completed

by the master or nominated responsible person o o

· I have agreed and understand the communication procedures o o

· I have agreed upon a reporting interval of....................minutes o o

· emergency and evacuation procedures have been agreed

and understood o o

· I am aware that the space must be vacated immediately

in the event of ventilation failure or if atmosphere tests

show a change from agreed safe criteria o o

Section 3 - Breathing apparatus and other equipment (To be jointly completed by the Master or nominated officer in charge and the person who is entering the space or, if more than one, the team leader)

Yes No

· Those entering the space are familiar with the breathing

apparatus to be used o o

· The breathing apparatus has been tested as follows:

- gauge and capacity of air supply............................

- low pressure audible alarm............................

- face mask - under positive pressure and not leaking............................

· The means of communication has been tested and emergency

signals agreed. o o

· All personnel entering the space have been provided with

rescue harnesses and, where practicable, lifelines o o

Signed upon completion of sections 1, 2 and 3 by:

Master or nominated officer in charge Date………….. Time ……………

Responsible person supervising entry Date………….. Time ……………

Person entering the space or

nominated team leader Date………….. Time ……………

Section 4 - Personnel entering the space (To be completed by the responsible person supervising entry)

Names Time in Time out

..............................................................................................................................

..............................................................................................................................

...............................................................................................................................

................................................................................................................................

Section 5 - Completion of job (To be completed by the responsible person supervising entry)

· Job completed Date..................... Time.....................

· Space secured against entry Date..................... Time.....................

· The officer of the watch has been

duly informed Date..................... Time.....................

Signed upon completion of sections 4 and 5 by

responsible person supervising entry Signed …………………………………..

Date..................... Time....................

STOP OR THIS PERMIT IS RENDERED INVALID SHOULD VENTILATION OF THE SPACE

IF ANY OF THE CONDITIONS NOTED IN THE CHECKLIST CHANGE

Notes:

· The permit should contain a clear indication as to its maximum period of validity.

· In order to obtain a representative cross-section of the space’s atmosphere, samples should be taken from several levels and through as many openings as possible. Ventilation should be stopped for about 10 minutes before the pre-entry atmosphere tests are taken.

· Tests for specific toxic contaminants, such as benzene or hydrogen sulphide, should be undertaken depending on the nature of the previous contents of the space.

· All persons in charge of entries into enclosed spaces, supervising entries or entering enclosed spaces shall be familiar and comply with Chapter 11 of the International Safety Guide for Oil Tankers and Terminals (ISGOTT) and Chapter 16, Section 8 of the Fleet Operating Procedures Manual (FOPM)

· The original of this permit shall be posted at the entrance to the enclosed space.

HOT WORK PERMIT

Vessel:_____________________________ Voyage No:__________

This permit to work relates to any work involving temperature conditions which are likely to be of sufficient intensity to cause ignition of combustible gases, vapour or liquids in or adjacent to the area involved. Before completing this form, refer to the accompanying guidance notes and to Section 2.8 of the ISGOTT (International Safety Guide for Oil Tankers and Terminals).

Please ensure that two copies are made, one being posted in the work area and one in file C6.2.

· GENERAL

This permit is valid from.....................hrs Date................................................…….

to......................…hrs Date...........................................…….......

Location of hot work............................................................................................……..

..........................................................................................................................………..

Has an enclosed space entry permit been issued? Yes / No

Reason if ‘No’:...........................................................................................……............

Description of hot work.......................................................................................………

.........................................................................................................................…………

Personnel carrying out hot work.....................................................................….……..

Person responsible for hot work.....................................................................………....

Person responsible for safety.........................................................................……….....

· SECTION 1

1.1 Has the hot work area been checked with a combustible gas indicator for

hydrocarbon vapours? Yes *………… /No Time............

1.2 Has the surrounding area been made safe? Yes / No Time............

1.3 Has the Ship Manager approved the work to be performed,

out of machinery space? Yes / No

* Value (LEL% or ppm)

· SECTION 2

2.1 Has the hot work area been checked with a combustible gas indicator for

hydrocarbon vapours? Yes*………… / No

2.2 Has the equipment or pipeline been gas freed? Yes / No

2.3 Has the equipment or the pipeline been blanked? Yes / No

2.4 Is the equipment or pipeline free of liquid? Yes / No

2.5 Is the equipment isolated electrically? Yes / No

2.6 Is the surrounding area safe? Yes / No

2.7 Is additional fire protection available? Yes / No

* Value (LEL% or ppm)

2.8 Special conditions/precautions.......................................................…..

................................................................................................................……

In the circumstances noted it is considered safe to proceed with this hot work.

Master Person in charge of hot work team

(name & signature) (name & signature)

· SECTION 3

The work has been completed and all persons under my supervision, materials & equipment have been withdrawn.

Authorised officer in charge........................... Time................Date..................

First copy for display at work area

Second copy for ship or terminal records.

GUIDANCE NOTES FOR HOT WORK PERMIT

· GENERAL

(a) Starting/finishing time must not exceed the Authorised Signatories’ / Responsible Officer’s working hours.

(b) Specific location of hot work to be given.

(b) Description of hot work to include type of equipment to be used.

· SECTION 1:

Applies to all hazardous work not involving naked flame or continuous spark production, and would include use of electrical equipment, use of air driven rotary equipment, sand or grit blasting, hammering and mechanical chipping and movement of equipment or materials over or near to machinery that is operating.

· SECTION 2

Applies to all hot work involving high temperatures, open flame, electric arc or continuous source of sparks etc. This type of work includes but is not limited to welding, burning and grinding.

TESTS FOR COMBUSTIBLE GAS SHOULD BE CARRIED OUT IMMEDIATELY BEFORE COMMENCEMENT OF HOT WORK AND AT FREQUENT INTERVALS AS LONG AS THE WORK IS IN PROGRESS.

COLD WORK PERMIT

Vessel:_______________________________ Voyage No:_________

This permit relates to any work in a hazardous or dangerous area which will not involve generation of temperature conditions likely to be of sufficient intensity to cause.ignition of combustible gases, vapours or liquids in or adjacent to the area involved.

Chief Engineer is responsible for determining the issuance of a Cold Work Permit, when the work is to be carried out within the engine room (i.e. if pressurized vessels and lines, sea lines, steam lines and fittings, etc are involved in the execution of the work, then a permit should be issued, before the work’s commencement.)

Please ensure that two copies of this form are made, one being posted in the work area and one in file C6.3.

· GENERAL

This permit is valid from.....................…..hrs Date....................................................

To..........................hrs Date....................................................

Location of cold work...............................................................................................

.............................................................................................................................…………..

Personnel carrying out cold work............................................................................………..

.............................................................................................................................…………..

Responsible person in attendance...........................................................................………...

· SECTION 1

Preparation and checks to be carried out by Officer in Charge of cold work to be performed.

1.1 The equipment/pipeline has been prepared as follows:

Vented to atmosphere: Yes / No Drained: Yes / No

Washed Yes / No Purged: Yes / No

Other........................................................................................................…….

1.2 The equipment/pipeline has been isolated as follows:

Lines Blanked: Yes / No Lines Disconnected: Yes / No

Valves Closed: Yes / No Other.....................................…

1.3 Is equipment free from:

Oil: Yes / No Gas: Yes / No H2S: Yes / No Steam: Yes / No Pressure: Yes / No

1.4 Is surrounding area free from hazards? Yes / No

1.5 If work is to be performed on electrical equipment has that equipment been isolated? Yes / No

· SECTION 2

Information and instructions to person carrying out cold work:

2.1 The following personal protection must be worn...............................…...

.....................................................................................................………

2.2 Equipment/pipeline contained following material in service.......................

....................................................................................................……….

2.3 Equipment expected to contain the following hazardous material when opened

..................................................................................................................

2.4 Special conditions/precautions.............................................................…...

...................................................................................................................

In the circumstances noted it is considered safe to proceed with this cold work.

Master/Responsible Officer Person carrying out work task

or in charge of cold work team

( name & signature) (name & signature)

· SECTION 3

The cold work has been completed and all persons under my supervision, materials and equipment have been withdrawn.

Authorised person in charge......................Time................. Date.......................

• First copy for display at work area
• Second copy for ship or terminal records.

PERSONAL PROTECTIVE EQUIPMENT RECEIPT

Vessel:__________________________________________

The undersigned______________________________________ rank__________________________

hereby certify that i am obliged and will use the under listed / received equipment, for my own safety and protection during the performance of my duties onboard the vessel and items marked with an (x) will be returned on my signing off.

Note:

In case that an item is not applicable to the seaman’s rank, it should be marked N/A.

#: Signature of Chief Officer or Chief Engineer.

_______________________________

Chief Officer Chief Engineer

(name & signature) (name & signature)

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