Pit Entry - Confined Space Permit

A permit must be issued for all forms of work being completed in Confined Spaces, these may include but is not limited to: Pit Working, Drains, Manholes

Complete all sections. Fields marked * are required. Do not start work until this permit has been authorised and accepted.

Part A

Work Details

Permit raised by *

Job title *

Sertec employee or contractor performing Confined Space Working *

Contractor details (if applicable)

Valid from — date *

Valid from — time *

Valid to — date *

Valid to — time *

Location of work *

Description and location of the Confined Space Working to be carried out *

Part B

Safety Precautions

All items must be checked before work commences. Mark each item as Required (Y/N) then confirm compliance.

Safety check Required? Y N

Does the confined space or work area require testing for noxious gases prior to working?

Do the persons in the confined space require radio equipment for contact purposes?

Does the area require purging prior to work commencement?

Does the work require isolation procedures? (If yes, LOTO procedure and permit to be used)

Persons in the area are permitted to enter or work in a confined space

Personal protective equipment is adequate for the risks involved

Entrances to the confined space are restricted to only nominated / trained persons

Alarm and escape routes are known

No persons are allowed to work alone in the pit area at any time (have they been told?)

Emergency rescue plan for employees / contractors is in place

Job specific instructions or precautions

Cancel

M & M

Permit to Work Portal — For internal and contractor use only