• CONFINED SPACE ENTRY PERMIT

    CONFINED SPACE ENTRY PERMIT

    WHS_007F
  • Before entering a confined space, is there an alternative way?*

  • PERMIT INFORMATION & CONDITIONS

    • This permit is required whenever work in a confined space has been identified.
    • Entry to the confined space shall only be allowed when the individual(s) have been trained and in the presence of a stand-by person.
    • The permit holder must keep the permit at the site where the work is being performed at all times.
    • Additional permits required (i.e. hot work) shall be attached to this permit before issue.
    • All persons involved in the works shall be instructed on the conditions and requirements before works commencing.
    • The permit is only valid for the date and time specified and is made invalid in the case of an emergency.
    • A SWMS MUST be completed before the work.
    • The Stand-by person(s) must monitor and maintain, watch and communication throughout the works.
    • This permit is not transferable and if conditions change a new permit shall be issued.
    • The permit holder is still obliged to carry out their work in a safe manner.
    • The permit is subject to relevant legislative requirements

  • Individuals Involved

  • CONFINED SPACE WORK DETAILS

  • THIS PERMIT IS ONLY VALID TODAY

  • Date
     - -

  • RISK CONTROL MEASURES / SAFETY REQUIREMENTS

  • Pipelines (water/steam/gas)*
  • Chemicals*
  • Electrical Energy Sources*
  • Thermal Energy*
  • Mechanical Energy Sources*
  • Lockout Danger Tags placed at isolation points*
  • Other*

  • PPE Required - Yes, always

  • Safety Helmet*
  • Eye Protection*
  • Gloves*
  • Steel-capped footwear*
  • Protective Clothing*
  • Respiratory Equipment*
  • Harness/Lifelines*
  • Personal Monitoring Equipment*
  • Additional Lighting*
  • Other*

  • RISK CONTROL MEASURES / SAFETY REQUIREMENTS

  • Confined Space Atmosphere

  • Has the atmosphere been tested?*
  • Has the space been purged?*
  • Is ventillation/extraction required?*

  • Conditions of Confined Space Entry

  • With respiratory protection device*
  • With retrieval equipment*

  • Emergency Preparedness

  • Response procedure in place?*
  • Response procedure rehearsed?*
  • Emergency Equipment identified and available? (winch, tripod, harness etc)*
  • Trained first aider available?*
  • Has fitness for entry been completed?*

  • ADDITIONAL PRECAUTIONARY REQUIREMENTS

  • Is a hot work permit required?*
  • If a hot work permit is required are the conditions complied with?
  • Has all equipment been inspected?*
  • Are communications systems in place?*
  • Is barricading and signage in place?*
  • Are all personnel Confined Space Trained?*
  • Are access and egress points clear?*

  • ATMOSPHERIC TESTING DETAILS

  • Calibrated: (date)*
     / /
  • Constant Monitoring Required?*
  • Test Results*

  • THIS WORK AREA HAS BEEN INSPECTED AND ALL IDENTIFIED RISK CONTROL MEASURES HAVE BEEN IMPLEMENTED

  • Permit issued by

  • Stand-by Person 1

  • By clicking Save Your Progress, you will receive an email with your started Confined Space Permit. You can continue completing it via the link in your email.

    • CONFINED SPACE ENTRY LOG 
    • AIR MONITORING LOG 
    • PERMIT CLOSURE / CANCELLATION 
    • Has the work been completed following the permit conditions?*
    • Has the confined space and surrounding area been inspected and made safe?*
    • Have all persons vacated the confined space and the entry point is secured?*

    • Stand-by Person

    • Permit issuer

    • NO FURTHER ENTRY IS ALLOWED WITHOUT ANOTHER PERMIT BEING ISSUED

    • WHS_007F_ConfinedSpaceEntryPermit_VersionAA_February2023

    • Clicking Save Your Progress will email you a copy of the form. Your progress is saved and you can continue working on your document at a later time.

      Clicking Finalise Your Permit will close the document from further enteries and send it to WHS.

       

      You don't have to create a user account to open your saved document, simply select continue at as guest.

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