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Confined Space Work Permit

This document is a work permit for confined space operations, outlining mandatory safety procedures and requirements for contractors. It includes sections for identifying hazards, safety checks, personal protective equipment (PPE), and contractor declarations. The permit must be closed after work completion, confirming that all safety protocols were followed and waste disposed of properly.

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158 views1 page

Confined Space Work Permit

This document is a work permit for confined space operations, outlining mandatory safety procedures and requirements for contractors. It includes sections for identifying hazards, safety checks, personal protective equipment (PPE), and contractor declarations. The permit must be closed after work completion, confirming that all safety protocols were followed and waste disposed of properly.

Uploaded by

prwankhede79
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Form No / REV No F/PA/23, 00

WORK PERMIT FOR CONFINED SPACE


Porcedure No SPR-02

Effec. Date 11.05.2018


Put wherever Applicable
This permit is Mandatory for all contractors such as in Confined Space work
New permit Permit extension Permit No.
Location of Work :
Permit Issue Date and Time :
Contractor's Name :

No of employees : Permit Closing date and Time

Nature of work :

Identify the hazards & risks in the work ( Write Yes/ No ) Safety Checks/Guide line for this particular work

Risk of falling from height : Easy to Access/any provision


Risk of object falling from height on
C.S.is thoroughly cleaned
head:
All the connecting lines are effectively
Foot injuries possible:
blanked
Checked inside Toxic gases and
Hand injuries possible:
flammable gases
Atmosphere inside the C.S.is checked for
Chance of eye injuries :
Oxygen-----%
Inside temp of C.S.is at or below room
Slippery floor :
temp
Chances of fire : Fresh Air supply is provided
Chances of Suffocation C.S. is electrically isolated.
Appointed Stand by person for out side of cs.
Used of 24 V lamp/Safety Torch
PPE for this particular work
Safety Helmet Safety goggles
Face Mask Safety shoes
Hand gloves SCBA-Self containing Breathing Apparatus
1 Is the risk & hazards explained to contractor
2 Is the emergency response plan made known to contractor
3 Is the EHS requirements made known to contractor
4 Availability of fire extinguishers ; first aid boxes made known to contractor.
Declaration by the contractor
I have understood the EHS requirement of EPPL, I will follow the instruction given to me and I will take the responsibility to safe working in
EPPL site.
Contractor : Permit initiated by : Dept Head EHS / HR Dept.

Permit closing
After Completion of work permit should be closed
I certify that I have completed the work specified in this permit. All my workmen and equipment have been removed from vicinity of the above
work and all genrated waste are disposed in proper manner as per hazardous waste rule

Contractor : Permit initiator Dept Head EHS / HR Dept.

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