FleetManagementLimited

CHECKLIST FOR ENTRY INTO ENCLOSED SPACES

MV/MT:
Date:
Sea/ Port/ Anchor:
Reason for Entry:
This permit is valid:

(For vessels with operational PARIS 9 or higher)

Ship Ref.:
Location/ Name of enclosed Space:
Present/ Last Cargo:
Cargo/ Ballast:

From

hrs Date
To
(Validity of this permit should not exceed 8 Hours)

hrs

Date

A. This permit fulfills the 'Risk Assessment' required for entering enclosed space entry. Before entering any enclosed space, all the
appropriate safety checks listed below must be carried out by a responsible officer and by the person in charge of entry team. A
separate checklist is to be filled for each compartment to be entered. If any of the below is marked as 'NO', it is essential that
permission is obtained from the company and a safe system of work agreed prior making entry.
B. All previously issued 'Safety Permits' should be revoked immediately upon vessel's berthing and fresh permit should be issued only
after obtaining permission from port/ terminal.

Section 1 - To be checked by a Responsible Officer:

Yes

No

N/A

1.1 Has the space been segregated by blanking off or isolating all connecting pipelines ?
1.2 Have the valves on all pipelines serving the space been secured to prevent their accidental opening ?
1.3 Has inert gas pressure of adjacent tanks been lowered to reduce possibility of any inter-tank leakage ?
1.4 Has the space been cleaned and thoroughly ventilated ?
1.5 Are crew members entering the enclosed space equipped with adequate PPE ?

PPE Requirement Protective clothing, Safety boots, Safety Helmet, Gloves, Safety Goggles, Safety Torch,
Walkie Talkie, EEBD and Personal Gas Detector
1.6 Pre-Entry atmosphere tests: (To be tested from outside the space)
Location of Checks

Height (m) Oxygen

LEL

Toxic Gas 1

PPM

TLV

Toxic Gas 2

PPM

TLV

Toxic Gas 3

PPM

TLV

Note: Pre-entry atmosphere tests should be carried out by sampling compartment at various depths and through as many deck openings to cover complete tank atmosphere. When tests are
being carried out from deck level, ventilation should be stopped and a minimum period of about 10 minutes should be allowed to elapse before readings are taken. Tests for specific
contaminants, such as benzene and H2S, should be undertaken depending on the nature of the previous contents of the space.

1.7 Atmosphere checks will be made at * 60 mins/ 90 mins/ 120 mins (* - delete as applicable) while the space is
occupied and also after work breaks ? (Note: The interval will depend upon nature of 'Enclosed Space' and duration of work).
LEL
Toxic Gases
Toxic Gases
Oxygen
LEL
Time
Time
Oxygen
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
1.8 Have arrangements been made for the space to be continuously ventilated throughout the period of occupation

and during work breaks ?

1.9 Is adequate illumination provided ?
1.10 Is rescue & resuscitation equipment available for immediate use by the entrance to the space ?

(SCBA/ Rescue Harness with lifeline, Approved Safety Torch)

1.11 Has a responsible person been designated to stand by the entrance to the space in direct contact with

Responsible Person./ Name and Rank of the Standby Person : ______________________________

1.12 Has the Officer of the Watch (Bridge. Engine Room, CCR) been advised of the planned entry and details

of persons entering/ time in-out for each entry will be logged down in QMS 68 ?
1.13 Has communication between the person at the entrance & those entering the space been agreed & tested?
1.14 Are emergency and evacuation procedures established and understood ?
1.15 If vessel is in port, has approval been obtained from port authorities ?
I am satisfied that all precautions have been taken and all safety arrangements will be maintained for entire duration of work.

Signature:

Rank:

Date:

Time:

Section 2 - To be checked by a Person In Charge of entry team. (Cadet or Trainee shall not be nominated as person incharge of entry team)
2.1 SECTION 1 of this permit has been completed fully.
2.2 I am aware that the space must be vacated immediately & in the event of ventilation failure or if atmosphere

tests change from agreed safe criteria.

2.3 I have agreed the communication procedures.
2.4 I have agreed upon a reporting interval of ____________ minutes.
2.5 Emergency and evacuation procedures have been agreed and are understood.
Names of all personnel entering:
I am satisfied that all precautions have been taken and all safety arrangements will be maintained for entire duration of work.

Signature:
Master

Rank:
Signature:

Date:

Time:

Date:

Time:

Section 3 - On completion of work

The work has been completed and all persons under my supervision, materials and equipment have been withdrawn.
Signed by a Responsible Officer:
Date:
Time:
DE23A
THIS PERMIT IS RENDERED INVALID SHOULD ANY OF THE CONDITIONS NOTED IN THE CHECKLIST CHANGE.

Rev809/11