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GRA.074 - Permit to Enter
Project
- None -
Site A
Site B
Site C
Site D
Site E
Contract Number
Permit Number
Permit Period
Start
End
Proposal
Name
Position
Exact Location
Nature of the work to be undertaken
Signed
Sign above
Date
Date: Date
Date: Time
To be completed by Person Responsible for undertaking the work
Details
Is entry to this confined space essential?
Yes
No
Description of tasks
Hazards identified (including any introduced by use of PPE etc)
Control measures and precautions necessary
Checklist
Safe access/egress for operatives, necessary equipment and services
Yes
No
N/A
Person Responsible
Adequate space to carry out work safely and space free from clutter and debris
Yes
No
N/A
Person Responsible
Operatives adequately trained and suitable for tasks and trained in use of any PPE that has to be worn
Yes
No
N/A
Person Responsible
Competent supervision on hand throughout job
Yes
No
N/A
Person Responsible
Incoming services isolated – (*delete as appropriate) gas*/electricity*/steam*/water*/fuel*/other*
Yes
No
N/A
Person Responsible
Installed equipment isolated mechanically/*electrically/*both (*delete as appropriate)
Yes
No
N/A
Person Responsible
Equipment and pipes/tanks have been drained and vented
Yes
No
N/A
Person Responsible
Potential ingress of fumes or other substances (e.g. excess rainwater if outside) has been evaluated and control measures arranged
Yes
No
N/A
Person Responsible
Residues, sludges or other potential causesof fume have been removed
Yes
No
N/A
Person Responsible
Atmospheric testing for oxygen*/toxic fumes*/flammables*has been carried out (*delete as appropriate)
Yes
No
N/A
Person Responsible
There are proven means and trained people prepared for evacuating a casualty from this confined space
Yes
No
N/A
Person Responsible
Suitable means of communication have been set up for those in the confined space to person/s on watch or outside at all times
Yes
No
N/A
Person Responsible
Suitable tools and equipment have been selected, and intrinsically safe electrical appliances if a flammable atmosphere may exist
Yes
No
N/A
Person Responsible
Adequate ventilation by natural air flow*/mechanical means* has been arranged (*delete as appropriate)
Yes
No
N/A
Person Responsible
Adequate lighting has been arranged
Yes
No
N/A
Person Responsible
Fire prevention arrangements*/fire extinguishers* are provided (*delete as appropriate)
Yes
No
N/A
Person Responsible
Any other precautions applicable to the job
Personal Protective Equipment and safety equipment needed (e.g. gas monitor) (specify)
Agreement
Date/Time of Issue
Date/Time of Issue: Date
Date/Time of Issue: Time
Method Statement Number
Controls Required
Permit Issued
Name
Signed
Sign above
Date
Date: Date
Date: Time
Duration of Permit
Start Time
Start Time: Date
Start Time: Time
Finish Time
Finish Time: Date
Finish Time: Time
Extended
Extended: Date
Extended: Time
To be completed by Person Approved to Issue Permits
Permit Received
Name
Signed
Sign above
Date
Date: Date
Date: Time
To be completed by the person in-charge of the work
Briefing Record
Briefing Record
Re-order
Name
Signed
Date
Weight
Operations
Name
Signed
Sign above
Date
Date: Date
Date: Time
Item weight
Add more items
more items
Works Completed
Name
Signed
Sign above
Date
Date: Date
Date: Time
To be completed by the Person In Charge Of Work
Works Completed
Name
Signed
Sign above
Date
Date: Date
Date: Time
To be completed by the person Approved To Issue Permits
