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APEX GLOBAL ENGINEERING SDN BHD (828911-T)

Attachment XIX
ENCLOSED SPACE ENTRY PERMIT
1. Vessel’s Name: Date: Location:
* Permit No: Control measures as identified by : JHA
* Vsl Name /PTW/Year / Running Number: JHA Reference No:
WORK DESCRIPTION:

2. PERMIT VALIDITY (The permit will be valid for 12 hrs only. A new permit to be applied if the duration exceeds 24 hours)
Permit Start Date: Time: Permit Expires Date: Time:
The permit is automatically suspended whenever an emergency alarm is activated. Work must stop and site made safe and permit return
to source.
(Tick box as appropriate)
3. ENTRY CHECK LIST YES NO
1 Space drained and gas free (if applicable, gas free certificate to be attached)
2 Pre-entry atmosphere test is made, atmosphere is found safe for entry (readings as follows)
Oxygen ……….. % Vol Hydrocarbon (% LFL): ………….. Toxic Gases (ppm): ……….. H2S Gases (ppm) ………..
3 Space is adequately ventilated, ventilation is maintained throughout entry.
4 LOTO - Valves closed, pumps stopped, pipes blanked when required, tag procedure is enforced.
5 Adequate illumination and safe access to space is provided.
6 Emergency rescue equipment is ready for use at entrance.
7 Stand-by personnel is nominated, briefed and attending at entrance.
8 Communication procedures are agreed and tested.
9 Others (Please specify):

4. SOURCES OF IGNITION ( Tick boxes where applicable )


Flame Cutting, Welding Welding Torch Igniters Chipping Sparks
Grit Blasting Explosives Others (Please specify):

5. SPECIAL PRECAUTIONS ( Tick boxes where applicable )


Fire watchers must be in attendance at all times Trips and alarms to be overridden
Gas, flame, and Smoke Detectors to be smoked or isolated Combustible materials removed or protected
Hazardous drains or vents in vicinity to be isolated Instruments, sensors and light fittings must be protected
Artificial ventilation must be provided at the worksite Isolation of electrical/instrument & mech power supply
Others (Please specify) :

6. PROTECTIVE EQUIPMENT ( Tick boxes where applicable )


Coverall/Safety helmets/Safety footwear/Safety spectacles
Ear muffs/Ear plugs Goggles/ Face visor Hood/Helmet Gloves/Gauntlets
Boots/ Chemical gloves Safety net Fire blankets Work vest/Life jacket
Safety warning signs Dust/Gas Respirator Self Contained BA Wet tarpaulin
Safety harness and lanyard Foam Ext. ( ) Dry Powder Ext. ( ) CO2 Ext. ( )

7. GAS TEST CERTIFICATE ( Tick boxes where applicable )


A. REQUIREMENT A GAS TEST IS REQUIRED NOT REQUIRED
B. The worksite is to be examined for:
OXYGEN FLAMMABLE GAS H2S OTHERS AS STATED.
C. FREQUENCY ( Frequency to be stipulated by Approval Signatory)
Gas testing must be carried out at the beginning of each shift or working day Once every : hour(s)
When work commences after a break of more than 30 minutes Continuous testing is required
D. RESULTS - The worksite specified in Section 7B was examined as follows:
Date Time % LEL PPM (CO) % O2 PPM (H2S) Examiner’s Name Signature

8. PERSONNEL ENTERING ENCLOSED SPACE


Name Rank Name Rank
APEX GLOBAL ENGINEERING SDN BHD (828911-T)

9. CLEARANCE APPROVAL
A. PERMIT APPLICANT B. APPROVAL FOR WORK SIGNATORY C. AUTHORIZING SIGNATURE
(Ch Officer or 2nd Engineer) (Master or Chief Engineer) (Master or Tech Superintendent)

I understand the precautions to be taken and I have inspected the worksite and satisfied I authorise work to commence
agree to fully comply with the Company that it has been properly prepared for the
instructions / requirements stated above. work as specified on this permit.
Sign: Date: Sign: Date: Sign: Date:
Name: Name: Name:
Rank: Rank: Rank:
Remark (if any): Remark (if any): Remark (if any):

10. WORK STOPPED / PERMIT SUSPENSION / RE- VALIDATION


Once work is stopped/permit suspended the application is to state the reason for stoppage/ suspension, inform the approver and authorizer
and endorse the “Work Stopped” column.
ACTION Work Stopped Work Stopped Work Stopped
Reason
Examples : (a) Unacceptable work conditions (b) End of working Day/Shift (c) Emergency alarm activated (d) Others - specify
Date:
Time:
Applicant
Sign:
ACTION Re-Validation Re-Validation
Date:
Time:
Applicant When the applicant is ready to
Sign: commence work again he has to
endorse the relevant revalidation
Date:
column. The approver is to ensure
Time:
Approver that the worksite is still in the
Sign: conditions specified in the permit
and the authorizer has to endorse
Date:
before work can resume.
Time:
Authorizer
Sign:

11. WORK COMPLETION ENDORSEMENT


A. PERMIT APPLICANT B. APPROVAL FOR WORK SIGNATORY C. AUTHORIZING SIGNATURE
(Ch Officer or 2nd Engineer) (Master or Chief Engineer) (Master or Tech Superintendent)

I have stopped work. The area has been I have visited the worksite and satisfied
I am satisfied that the work has stopped
restored to a safe and operational condition. myself that the work has stopped. The area
and the area restored to a safe and
has been restored to a safe and operational
operational condition.
condition.
Signature: Date: Signature: Date: Signature: Date:
Name/Rank Name/Rank Name:
Remark (if any): Remark (if any): Remark (if any):

PERMIT DISTRIBUTION
ORIGINAL - To be displayed on the Bridge till completion and Master COPY – To be displayed at the worksite till completion.
to keep for record.

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