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LARSEN & TOUBRO LIMITED EHS-SOP03-F03C

EHS CAPABILITY CENTRE R01


CONFINED SPACE ENTRY PERMIT
General Information

Valid From ____________ AM/PM Date______


To _______ AM/PM Date ___________________

Nature of work:- ____________________________________________________________________

Exact Location of work:- __________________________________________


Area:- ________________________________________________________

Equipment to be use (Specify Valid Certificate No if any) :- ____________________________________________________________


Name Of Contractor:- Name of Incharge:- Maximum no. of people allowed:
The following items must be checked before issuing the permit
Item Y N NA Item Y N NA
Vessel/Equipment / work area inspected / Proper identification and communication of Hot surfaces inside confined
1 O O O 13 O O O
Hazards explained to workmen space (pre heated surfaces for welding etc.)

Surrounding area checked / cleaned up


Proper ventilation (blower / exhaust fan) provided
2 flammable materials / oil / rags / grass / gas O O O 14 O O O
cylinder etc. removed or appropriately placed

Vessel/Equipment / work area blinded /


3 O O O 15 24V lighting hand lamp provided & sufficient illumination ensured O O O
disconnected / closed isolated / wedged open.

No leakage ensured for Oxygen / LPG / Acetylene, etc. hose pipes inside
4 Vessel/Equipment / work area completely O O O 16 O O O
confined space
drained / depressurised

Vessel/Equipment / work area properly steam


5 O O O 17 Fire Extinguisher / water line provided for fire fighting. O O O
purged.

6 Vessel/Equipment / work area water flushed O O O 18 All persons provided with proper PPE & life line (if applicable) O O O

All persons going inside confined space are trained on confined space
Vessel/Equipment / work area properly Locked &
7 O O O 19 entry requirements, including emergency communication & escape O O O
Tagged (LOTO ensured)
measures

Considered hazards from other routine / non-


8 routine operations & concerned persons alerted. O O O 20 Proper portable ladder & Proper means of exit provided O O O
Cautionary board of "CONFINED SPACE WORK -
Entry of Authorized persons only" deployed.

Oxygen deficiency test done (oxygen level 19.5% -


23%), Flammable gas level checked and is below
10% of LEL, Toxic gas level checked and is below Suitable scaffolding provided (green tag checklist requirement
9 O O O 21 O O O
the safe limit (H2S < 10 PPM for 8 Hrs; CO < 35 fulfillment)
PPM for 8 Hrs) & Valid calibration of Multi Gas
Detector
Gas cylinders / Welding machines / Electric DBs Is Entry/Exit Register available and Standby personnel provided for
10 O O O 22 O O O
kept outside confined space. vessel entry.

Has a rescue team equipped with emergency rescue devices put on


11 No electrical cable joints inside confined space. O O O 23 O O O
standby

MSDS of any chemical or hazardous subtance in


12 O O O 24 Provision of rope in closed vessel for rescue, whistle for warning etc. O O O
use deployed at the workstation.

Additional permit required and/or attached:- No O Yes O (if yes specify:-

# Sensitivity : This Document is Classified as "LNT Internal Use".


TESTING RECORD
Date Time Meter Reading Signature of To be signed only after completing the job
Signature Signature
of FlammabilityToxic Gases (PPM)Signature of
O2 of site of site Issuing Signature of Signature
Signature
of of RCM/RE
From TO Sub-Contractor Engineer EHSO
Work (% LEL)
ContentH2S
% & CO Supervisor Authority site Engineer EHSO Issuing authority

Special Instrucitons:
1 This permit must be available at the work site at all times.
2 Location & Description of work must be clearly indicated by the permittee.
3 Terms applicable must be clearly inidcated by the permittee.
4 All precautions given in permit must be strictly adhered to by the permittee.
5 This permit shall be renewed each day only after checking all the compliance jointly by L & T and the contractor.
6 Permit renewal-for not more than 7 times including the issue date.
7 Permit shall be returned to issuer after completing the job.
In case of change of state or activity inside or outside the confined space which poses new or different hazards, new permit to be taken
8
9 The Multi Gas detector to be calibrated according to Time Weighted Average (TWA - 8 Hrs.)
Criterias like limited access & egress, oxygen deficiency, no or scarce ventilation, presence of flammable / toxic gases, no or low illumination can be taken to qualify the
10
area as confined space. Eg: Vessels, Tanks, Ducts, ESP Electrode cavity, CW pieline, Boiler roof panel penthouse, Transit Mixer Drum, TG / Condenser etc.

Additioanal information if any:-(optional)

TO BE SIGNED AFTER CHECKING FOR THE COMPLIANCE


All the points mentioned in the above checklist heve been checked & found OK.

(Permit Intiator) (L & T Engineer) (L & T-EHSO) (Issuing Authority)


TO BE SIGNED AFTER THE WORK IS OVER.
I hear by confirm that permited area cleared and safe for use.

(Permit Intiator) (L & T Engineer) (L & T-EHSO) (Issuing Authority)

# Sensitivity : This Document is Classified as "LNT Internal Use".

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