ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
CONFINED SPACE PERMIT | ALANGHSE-CS-02 REV. 01 Controlled Form |
| SECTION 1: REQUISITION / CONTROL INFORMATION | |||
| 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 |
| SECTION 2: GAS READINGS | SECTION 3: PERMISSIBLE LIMITS | ||||
O2[ GAS_O2 ] |
LEL[ GAS_LEL ] |
CO[ GAS_CO ] |
H2S[ GAS_H2S ] |
O2: 20.6 - 21.0% | LEL: < 1% H2S: < 5.0 PPM | CO: < 25 PPM |
|
| Subsequent readings in F-40F. | |||||
| SECTION 4: COMPLIANCE MATRIX | ||||
| CHECK / CRITERIA | YES | NO | N/A | REMARKS |
| PREPARATION & ISOLATION | ||||
| 1. Confined space identified, barricaded, warning signage displayed. | ☑ |
[ Q2_RMK ] | ||
| 2. Proper access ladder / safe means of entry and exit is provided. | ☑ |
[ Q5_RMK ] | ||
| 3. No ingress of water, gas, oil, chemical expected. | ☑ |
[ Q9_RMK ] | ||
| 4. Connected pipelines/energy sources isolated/locked/blinded. | ☑ |
[ Q10_RMK ] | ||
| 5. Safe for Entry / Gas Reading label is displayed. | ☑ |
[ Q15_RMK ] | ||
| 6. Combustion engine equipment placed outside and away. | ☑ |
[ Q18_RMK ] | ||
| 7. Permit will be displayed near the confined space entry point. | ☑ |
[ Q20_RMK ] | ||
| GAS MONITORING & VENTILATION | ||||
| 8. Continuous ventilation is provided and maintained. | ☑ |
[ Q3_RMK ] | ||
| 9. Initial gas reading taken and recorded in Permit. | ☑ |
[ Q6_RMK ] | ||
| 10. Pocket multi-gas detector provided to entrant / attendant. | ☑ |
[ Q7_RMK ] | ||
| 11. Gas concentrations are within allowable limits. | ☑ |
[ Q8_RMK ] | ||
| PERSONNEL & EMERGENCY CONTROLS | ||||
| 12. Pre-job meeting / toolbox talk completed. | ☑ |
[ Q1_RMK ] | ||
| 13. Lighting, access and approach to the work area are adequate. | ☑ |
[ Q4_RMK ] | ||
| 14. Dedicated attendant is posted outside and is aware of emergency procedure. | ☑ |
[ Q11_RMK ] | ||
| 15. Emergency equipment is available near the confined space. | ☑ |
[ Q12_RMK ] | ||
| 16. Emergency escape route is clear and unobstructed. | ☑ |
[ Q13_RMK ] | ||
| 17. Rescue team details displayed and team informed before entry. | ☑ |
[ Q14_RMK ] | ||
| 18. Entrants are trained and authorized for confined space entry. | ☑ |
[ Q16_RMK ] | ||
| 19. Communication method established and tested. | ☑ |
[ Q17_RMK ] | ||
| 20. Entry / exit tracking register (F-19C) maintained by attendant. | ☑ |
[ Q19_RMK ] | ||
| SECTION 5: PPE + SECTION 6: EMERGENCY READINESS | ||||
☑ S.C.B.A (4) |
☑ E.E.B.D (4) |
☑ First Aid Box |
☑ Safety Helmet |
☑ Coveralls |
☑ Stretcher |
☑ Mech blower |
☑ Tripod |
☑ Filter mask |
☑ Gumboot |
☑ Rubber gloves |
☑ Cotton gloves |
☑ Leather gloves |
☑ Disposal suit |
☑ Safety Goggles |
| SECTION 7: JOINT INSPECTION & AUTHORISATION MATRIX | ||
| A. PERMIT APPLICANT | B. HSE APPROVAL | C. PERMIT CONTROLLER / PM-GM |
|
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: |
I am satisfied with safety precautions and hereby give permission to commence work.
Name: VISHAL PANDEY
Designation: Safety Officer / HSE Manager Signature: |
Approval by Plot Manager (PM) / General Manager (GM).
Name: VISHAL PANDEY
Designation: PM/GM Signature: |
| SECTION 8: SPECIAL INSTRUCTIONS / ACKNOWLEDGEMENT |
|
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, or communication failure.
I have read and understood all instructions above and have explained them to all workers engaged in the work.
Mukadam Signature: _____________________ Date: 2026-08-10 |
| SECTION 9: PERMIT RETURN | |||||
| ✓/X | STATUS | PERSON | SIGNATURE | TIME | |
☑ |
Permit is closed; job is completed. Remark: All workers exited. 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 |