ALANGHSE SERVICES PERMIT

ALANGHSE SERVICES

CONFINED SPACE PERMIT

ALANGHSE-CS-02
REV. 01
Controlled Form

SECTION 1: REQUISITION PERMIT IDENTIFICATION
Applicant/Mukadam	VISHAL PANDEY	Ship Name	VISHAL PANDEY
Location / Tank Name	[ CS_LOC_DESC ]
Workers / Attendant	VISHAL PANDEY / [ CS_ATTENDANT ]
Date / Issue Time	2026-08-10 / 08:00 AM	Valid up to / Permit No.	[ CS_VALID ] / [ CS_PERMIT_NO ] A/B
JHA Report No.	[ CS_JHA ]	Ext. Competent Person Permit No.	[ CS_EXT_PERMIT ]

SECTION 2: ASSOCIATED PERMITS

SECTION 3: ACTIVITY

☑ Hot work permit	☑ Cold work Permit
☑ Work at height permit	☑ Other/ _________________

☑ Hot work	☑ Cold work
☑ Tank cleaning	☑ Other/ _________________

SECTION 4: WORK SITE PREPARATION / PRECAUTION

WORK AREA & ENVIRONMENT

EQUIPMENT & CHECKS

PEOPLE, PPE & AUTHORIZATION CONTROLS

Yes

Confined space identified, barricaded, warning signage displayed.

Yes

Continuous ventilation is provided and maintained.

Yes

Lighting, access and approach to the work area are adequate.

Yes

Gas concentrations are within allowable limits.

Yes

No ingress of water, gas, oil, chemical expected.

Yes

Emergency escape route is clear and unobstructed.

Yes

Combustion engine equipment placed outside and away.

Yes

Proper access ladder / safe means of entry and exit is provided.

Yes

Initial gas reading taken and recorded in Permit.

Yes

Pocket multi-gas detector provided to entrant / attendant.

Yes

Connected pipelines/energy sources isolated/locked/blinded.

Yes

Emergency equipment is available near the confined space.

Yes

Safe for Entry / Gas Reading label is displayed.

Yes

Permit will be displayed near the confined space entry point.

Yes

Pre-job meeting / toolbox talk completed.

Yes

Dedicated attendant is posted outside and is aware of emergency procedure.

Yes

Rescue team details displayed and team informed before entry.

Yes

Entrants are trained and authorized for confined space entry.

Yes

Communication method established and tested.

Yes

Entry / exit tracking register (F-19C) maintained by attendant.

SECTION 5: MULTI GAS DETECTOR READING (First Reading)					SECTION 6: GAS LIMITS
LOCATION	O2 [%]	CH4 [%]	CO [ppm]	H2S [ppm]	O2 (OXYGEN): 20.6 to 21.0 (%) CH4 (METHANE): < 1% LFL (0.05% V/V) H2S: < 5.0 PPM (50% OEL) CO: < 25 PPM (50% OEL)
[ CS_LOC_DESC ]	[ GAS_O2 ]	[ GAS_LEL ]	[ GAS_CO ]	[ GAS_H2S ]

SECTION 7: PPE					SECTION 8: EMERGENCY ITEMS
☑ Safety Helmet	☑ Coveralls	☑ Filter mask	☑ Gumboot	☑ Safety Shoes	☑ S.C.B.A (4)	☑ E.E.B.D (4)	☑ First Aid Box
☑ Rubber gloves	☑ Cotton gloves	☑ Leather gloves	☑ Disposal suit	☑ Safety Goggles	☑ Stretcher	☑ Mech blower	☑ Tripod

SECTION 7: AUTHORISATION CARD
PERMIT APPLICANT I am satisfied that all precaution has been taken and all safety arrangements will be maintained for entire duration of work. Name: VISHAL PANDEY Designation: Ship / Yard Supervisor Signature:	APPROVAL BY HSE DEPARTMENT I am satisfied with safety precautions and hereby give permission to commence work. Name: VISHAL PANDEY Designation: Safety Officer / HSE Manager Signature:	PERMIT CONTROLLER / PM-GM Approval by Plot Manager (PM) / General Manager (GM). Name: VISHAL PANDEY Designation: PM/GM Signature:

SECTION 10: MANDATORY WORK RULES

1. If "DO NOT ENTER" is displayed anywhere, never enter and do not allow anyone to enter without the required permit.
2. Gas checks are mandatory before entering any confined space and after any rest breaks.
3. At least one attendant must remain stationed outside the confined space at all times.
4. Permit shall be suspended if there is gas alarm activation, ventilation failure, communication failure, change in job scope, hot work in adjacent space, or after any emergency alarm.
5. Return the permit to the Safety Officer / HSE Manager immediately after the work is completed.

Mukadam acknowledgement: I have read, understood and explained these instructions to all workers.
Signature: _____________________ Date: 2026-08-10

SECTION 11: PERMIT RETURN (PLEASE TICK WHERE APPLICABLE)
✓/X	STATUS	PERSON	SIGNATURE	TIME
☑	Permit is closed; job is completed. Remark: All workers have exited the confined space and headcount is confirmed. Tools/hoses removed. Space safely secured.	Mukadam		08:00 AM
		Safety Officer

SECTION 10: EMERGENCY CONTACT NUMBERS
SL. NO.	DESIGNATION	NAME	CONTACT NO.
1	HSE MANAGER	ROCKY SINGH	7990404108
2	PLOT MANAGER	PRAVIN SHIYAL	79846 07070

Note: Personnels are recommended to move to fresh air after a maximum of 90 minutes per entry. First gas readings in Section 5. Subsequent readings in F-40F.
This Permit is Valid for maximum 08 Hours Only including rest hours.

FORMAT PREPARED BY: HSE MANAGER APPROVED BY: GENERAL MANAGER