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ALANGHSE SERVICES		 CONFINED SPACE ENTRY PERMIT
सीमित / बंद स्थान और प्रवेश परमिट		 ALANGHSE-F-02
REV. 01
Controlled Form
SECTION 1: REQUISITION / मांग
Date2026-08-10 Issue Time08:00 AM Valid up to08:00 AM Permit No.[ CS_PERMIT_NO ]
Applicant NameVISHAL PANDEY Ship NameVISHAL PANDEY
Location / Tank Name[ CS_LOCATION ] JHA Report No.[ CS_JHA ]
Name of WorkersVISHAL PANDEY Vessel/CS Ext. Permit[ EXT_PERMIT_NO ]
Name of Attendants[ CS_ATTENDANT ]
SECTION 2: ASSOCIATED PERMITS SECTION 3: ACTIVITY
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Safe for Entry [ LINKED_SAFE_ENTRY ]
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Hot work permit [ LINKED_HOT_WORK ]
गर्म काम की अनुमति नं.
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Cold work Permit [ LINKED_COLD_WORK ]
ठंडा काम की अनुमति नं.
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Work at height permit [ LINKED_WORK_AT_HEIGHT ]
ऊंचाई पर कार्य परमिट नं.
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Other: ☑
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Hot work / गर्म काम
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Cold work / ठंडा काम
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Tank cleaning / टैंक की सफाई
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Other: ☑
SECTION 4: WORK SITE PREPARATION / PRECAUTION
ITEMS CHECK YESNON/AREMARKS
1. Pre-job meeting / toolbox talk completed. मीटिंग पूरी की गई है।
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[ Q1_RMK ]
2. Confined/enclosed space has been physically identified, barricaded and warning signage displayed. सीमित / बंद स्थान की भौतिक रूप से पहचान कर ली गई है, उसे बैरिकेड किया गया है।
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[ Q2_RMK ]
3. Continuous ventilation is provided and maintained. निरंतर वेंटिलेशन की व्यवस्था है।
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[ Q3_RMK ]
4. Lighting, access and approach to the work area are adequate. प्रकाश और पहुंच पर्याप्त है।
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[ Q4_RMK ]
5. Proper access ladder / safe means of entry and exit is provided. उचित सीढ़ी उपलब्ध है।
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[ Q5_RMK ]
6. Initial gas reading has been taken by Safety Officer / HSE Manager and recorded in Section 9.
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[ Q6_RMK ]
7. Pocket multi-gas detector is provided to entrant / attendant for continuous monitoring, as applicable.
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[ Q7_RMK ]
8. Gas concentrations are within allowable limits as per Section 8. गैस स्वीकार्य सीमा के भीतर है।
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[ Q8_RMK ]
9. No ingress of water, sludge, steam, gas, oil, chemical or other hazardous substance into the confined/enclosed space is expected.
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[ Q9_RMK ]
10. Connected pipelines, valves, pumps, electrical sources, mechanical drives and other energy sources are isolated / locked / tagged / blanked / blinded or positively secured, wherever applicable.
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[ Q10_RMK ]
11. Dedicated attendant is posted outside the confined/enclosed space and is aware of emergency procedure.
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[ Q11_RMK ]
12. Emergency equipment is available near the confined/enclosed space. आपातकालीन उपकरण उपलब्ध हैं।
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[ Q12_RMK ]
13. Emergency escape route is clear and unobstructed. निकास मार्ग अवरोध रहित है।
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[ Q13_RMK ]
14. Rescue team details are displayed near the entry point and the rescue team has been informed before entry.
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[ Q14_RMK ]
15. Safe for Entry / Safe for Hot Work / Gas Reading label is displayed, as applicable.
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[ Q15_RMK ]
16. Entrants are trained and authorized for confined/enclosed space entry. प्रवेश करने वाले श्रमिक प्रशिक्षित हैं।
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[ Q16_RMK ]
17. Communication method between entrant, attendant and rescue team is established and tested.
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[ Q17_RMK ]
18. Combustion engine equipment / diesel generator / fire pump is placed outside and away from the confined/enclosed space.
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[ Q18_RMK ]
19. Entry / exit tracking register or F-19C is available and will be maintained by the attendant.
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[ Q19_RMK ]
20. Permit will be displayed near the confined/enclosed space entry point. परमिट प्रदर्शित किया जाएगा।
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[ Q20_RMK ]
ALANGHSE SERVICES FORMAT 01 CLASSIC CONTROLLED FORM Page 1 of 3
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ALANGHSE SERVICES		 CONFINED SPACE ENTRY PERMIT
सीमित / बंद स्थान और प्रवेश परमिट		 ALANGHSE-F-02
REV. 01
Controlled Form
SEC 5: PPE / पीपीई SEC 6: EQUIPMENT / उपकरण SEC 7: EMERGENCY ITEMS / आपातकालीन उपकरण
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Safety Helmet हैलमेट
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Coveralls ड्रेस
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Filter mask फ़िल्टर मास्क
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Safety Shoes सेफटी जूता
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Rubber gloves रबड़ के दस्ताने
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Cotton gloves रूई के दस्ताने
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Leather gloves चमड़े के दस्ताने
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Disposal suit डिस्पोज़ेबल सूट
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Safety Goggles सेफटी चसमा
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Multi-gas detector (GMI PS 241)
Model: 348793, Cal valid 18-09-2026
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Pocket gas detector (ALTAIR 4X)
Model: 6006494, Cal valid 15-08-2026
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Safety Harness सेफ्टी हर्नेस
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Min. two Mechanical blowers यांत्रिक ब्लोअर
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Non-flam. Light गैर-ज्वलनशील प्रकाश
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Walkie-Talkie वॉकी-टॉकी
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Natural Ventilation प्राकृतिक वायु संचार
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Portable Torch पोर्टेबल टॉर्च
Others: _______________
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At least 4 (four) S.C.B.A sets
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At least four (4) E.E.B.D or ELSA
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First Aid Box प्राथमिक उपचार डिब्बा
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Stretcher स्ट्रेचर
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At least 1 spare Mechanical blower
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Tripod with sufficient wire rope length
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Pilot Ladder पायलट सीढ़ी
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At least 2 Safety Harnesses
Other/अन्य: _________________
SECTION 8: ACCEPTABLE LEVEL OF GAS CONCENTRATIONS AS PER RSR, 2026 and MEPC 210 (63)
O2 (OXYGEN)CH4 (METHANE)/ HC* in % H2S (HYDROGEN SULPHIDE) in PPMCO (CARBON MONOXIDE) in PPM
20.8±0.2 (%) or 20.6 to 21.0 (%) ≤1% of Lower Flammable Limit (LFL) =
0.05% V/V Methane in Air=0.0005 by Fraction.		 ≤50% of Occupational Exposure Limit
[OEL], i.e., 50% of 10 PPM = 5.0 PPM		 ≤50% of Occupational Exposure Limit
[OEL], i.e., 50% of 50 PPM = 25 PPM
CONFINED SPACE, CS ( ) [ CS_O2 ] [ CS_LEL ] [ CS_CO ] [ CS_H2S ] [ CS_LUX ] [ CS_TEMP ] 08:00 AM
ADJACENT SPACE (ADJ-1) [ ADJ1_O2 ] [ ADJ1_LEL ] [ ADJ1_CO ] [ ADJ1_H2S ] [ ADJ1_LUX ] [ ADJ1_TEMP ] 08:00 AM
ADJACENT SPACE (ADJ-2) [ ADJ2_O2 ] [ ADJ2_LEL ] [ ADJ2_CO ] [ ADJ2_H2S ] [ ADJ2_LUX ] [ ADJ2_TEMP ] 08:00 AM
ADJACENT SPACE (ADJ-3) [ ADJ3_O2 ] [ ADJ3_LEL ] [ ADJ3_CO ] [ ADJ3_H2S ] [ ADJ3_LUX ] [ ADJ3_TEMP ] 08:00 AM
ADJACENT SPACE (ADJ-4) [ ADJ4_O2 ] [ ADJ4_LEL ] [ ADJ4_CO ] [ ADJ4_H2S ] [ ADJ4_LUX ] [ ADJ4_TEMP ] 08:00 AM
JOINT INSPECTION / APPROVALS
PERMIT APPLICANT
Name: VISHAL PANDEY


Signature 		HSE DEPARTMENT
Name: VISHAL PANDEY


Signature 		PERMIT CONTROLLER (PM/GM)
Name: VISHAL PANDEY


Signature
SECTION 11: SPECIAL INSTRUCTION/ कुछ जरुरी सुचना जो मूकादम को परमिट लेने से पहले जानकारी लेना जरुरी हैI
अगर कहीं भी “DO NOT ENTER” लिखा हुआ हो तो कभी भी अन्दर न जाये और ना ही किसी को जाने दे जब तक आपके पास परमिट न हो
नियर मिस कभी भी छुपाने की कोसिस न करे, उसे फौरन सेफ्टी ऑफिसर/एचएसई प्रबंधक को रिपोर्ट करे
बंद जगह मे प्रवेश करने से पहले गैस चेक करना जरूरी है
बंद जगह मे प्रवेश करने से पहले आपातकाल मे उपयोग होने वाली उपकरण तैयार और अछि कंडिशन मे होना चाहिए!
बंद जगह मे काम करने के लिए कम से कम एक निरीक्षण करने वाला ब्यक्ति हमेसा उपस्थित होना चाहिए
काम समाप्त होने के तुरंत बाद परमिट सेफ्टी ऑफिसर/ एचएसई प्रबंधक को लौटा दे!
परमिट मे जिस जगह की परमिट दी गयी है उसके अलावा किसी अन्य जगह पर काम न करे

मैं VISHAL PANDEY ऊपर दिए गए सभी निर्देशों को सही से पढ़ और समझ लिया है तथा कार्य में लगे सभी कार्यकर्ताओं को भी समझा दिया गया है। कार्य पूर्ण होने तक उपर्युक्त निर्देशों का पूर्ण रूप से पालन किया जाएगा।

मूकादम का हस्ताक्षर / Applicant Signature: _________________________     तारीख / Date: 2026-08-10
ALANGHSE SERVICES FORMAT 01 CLASSIC CONTROLLED FORM Page 2 of 3
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ALANGHSE SERVICES		 CONFINED SPACE ENTRY PERMIT
सीमित / बंद स्थान और प्रवेश परमिट		 ALANGHSE-F-02
REV. 01
Controlled Form
SECTION 12: PERMIT RETURN (PLEASE TICK WHERE APPLICABLE)
✓/x STATUS PERSON NAME SIGNATURE TIME REMARK
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 Permit is closed; job is contd. Please issue new permit Mukadam VISHAL PANDEY 08:00 AM All workers have exited the confined/enclosed space and headcount is confirmed. Tools, hoses, cables and equipment have been removed or safely secured. Space has been barricaded / closed / handed over safely.
Safety Officer VISHAL PANDEY
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 Permit is closed; job is completed Mukadam VISHAL PANDEY
Safety Officer VISHAL PANDEY
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 Permit is cancelled, as present conditions are not conductive to carrying out the work
REMARKS: Closure: [ CLOSURE_REMARKS ]
Cancellation: [ CANCELLATION_REASON ]
SECTION 13: EMERGENCY CONTACT NUMBERS
Sl. No.NameDesignationContact No.
1.ROCKY SINGHHSE MANAGER7990404108
2.PRAVIN SHIYALPLOT MANAGER79846 07070
3.YASHWANT KUMARSAFETY SUPERVISOR9919105676
4.KABIR PRASADHEAD MUKADAM97255 40346
5.VISHAL PANDEYSAFETY OFFICER7607735559
6.BRAHMDEO MAHTOSHIP SUPERVISOR6352049759
7.RAVINDAR PRASADSAFETY OFFICER8980881990
SECTION 14: EMERGENCY RESPONSE TEAMS (FIRE FIGHTING, FIRST AID, RESCUE TEAM AND SPILL RESPONSE TEAM)
FIRE FIGHTING TEAMFIRST AID TEAM
RoleNameContact No. RoleNameContact No.
TLVishal Pandey7607735559TLVISHAL PANDEY7607735559
ATLRamkumar Tiwari7488021556ATLBRAHMDEO MAHTO6352049759
M1Prakash prasad9601783304M1AJAY KUMAR MAHTO6205113253
M2Kuldeep7359664509M2DAULAT MAHTO8264059370
M3Sanjay Singh9510080931M3ASHOK VERMA9173843356
RESCUE TEAMSPILL RESPONSE TEAM (OIL/CHEMICAL)
TLYASHWANT KUMAR9919105676TLVISHAL PANDEY7607735559
ATLKESHLAL YADAV7703090445ATLARVIND BHARATI9099490783
M1JUGESH8052923866M1SONU GOND7227896163
M2KESHRAM6355274105M2VIPUL BARAIYA9904778095
M3DASHRATH9725167925M3
Abbreviations: SCBA – Self-Contained Breathing Apparatus, EEBD - Emergency Escape Breathing Device, ELSA - Emergency Life Support Apparatus, O2- Oxygen, CH4- Methane, H2S- hydrogen Sulphide, CO- Carbon monoxide, LEL- Lower explosive limit, PPM- Parts Per Million, TL – Team Leader, ATL – Assistant Team Leader, M-Member, RSR –Recycling of Ship Regulation, 2026, HC - Hydrocarbon
Note:
1. Every worker has the responsibility and authority to stop work immediately, without fear of reprisal, when he believes conditions exist that pose a risk to the health and safety of personnel or the public, compromise safe operations or damage facilities or the environment, or could result in an uncontrolled release of hazardous substances beyond regulatory limits.
2. In case of mechanical system failure or general lighting system failure, the Safety Officer / HSE Manager shall be re-called, and the “Entry Permit” shall become void until it is re-authorized by the HSE Manager / Plot Manager. Permit shall be suspended and revalidated if there is gas alarm activation, ventilation failure, communication failure, change in job scope, change in space condition, hot work in adjacent space, liquid/gas ingress risk, or after any emergency alarm.
3. If the fire alarm or evacuation alarm is activated, the confined space shall be evacuated immediately, and re-entry shall be permitted only after an all-clear is given by the Safety Officer / HSE Manager.
4. Check gas after each rest break (10.30 AM, 1.00 PM, 3.30 PM or at the prescribed rest breaks or at another formally approved schedule) or whenever the confined space has remained unattended for more than 30 mins. It is recommended that the interval between two consecutive atmospheric checks should not exceed 90 minutes. The first gas readings shall be recorded in Section 09 of this permit format. All subsequent gas readings, until permit closure, shall be recorded in Form F-40F – Periodic Gas Level Check Record.
5. Personnel are recommended to move to fresh air after a maximum of 90 minutes per entry, including travel time within the confined space.
6. A separate log sheet (F-19C – Onboard Visitors / Workers Tracking Record – Embarkation Point / Confined Space) shall be maintained to record the entry and exit times of all personnel entering and leaving the confined space during the validity of the permit. The designated attendant stationed outside the confined space shall be responsible for monitoring and recording all entries and exits.
7. A separate permit shall be issued for any work exceeding eight (8) hours per shift, including rest hours.
8. No person shall enter the confined/enclosed space for rescue unless trained, authorized and equipped with suitable rescue equipment / SCBA, as applicable. Emergency rescue shall be carried out as per EPRP.
ALANGHSE SERVICES FORMAT 01 CLASSIC CONTROLLED FORM Page 3 of 3