ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
CONFINED SPACE PERMIT | ALANGHSE-CS-02 REV. 01 Controlled Form |
| STEP 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 ] |
| STEP 2: ASSOCIATED PERMITS / ACTIVITY | |
| ASSOCIATED PERMITS | ACTIVITY |
|
☑ Hot work permit☑ Cold work Permit☑ Work at height permit☑ Other/ _________________ |
☑ Hot work☑ Cold work☑ Tank cleaning☑ Other/ _________________ |
| STEP 3: PRE-WORK SAFETY VERIFICATION | |||||||
| CRITERIA | Y | N | N/A | CRITERIA | Y | N | N/A |
| 1. Pre-job meeting / toolbox talk completed. | ☑ |
11. Dedicated attendant is posted outside and is aware of emergency procedure. | ☑ |
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| 2. Confined space identified, barricaded, warning signage displayed. | ☑ |
12. Emergency equipment is available near the confined space. | ☑ |
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| 3. Continuous ventilation is provided and maintained. | ☑ |
13. Emergency escape route is clear and unobstructed. | ☑ |
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| 4. Lighting, access and approach to the work area are adequate. | ☑ |
14. Rescue team details displayed and team informed before entry. | ☑ |
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| 5. Proper access ladder / safe means of entry and exit is provided. | ☑ |
15. Safe for Entry / Gas Reading label is displayed. | ☑ |
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| 6. Initial gas reading taken and recorded in Permit. | ☑ |
16. Entrants are trained and authorized for confined space entry. | ☑ |
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| 7. Pocket multi-gas detector provided to entrant / attendant. | ☑ |
17. Communication method established and tested. | ☑ |
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| 8. Gas concentrations are within allowable limits. | ☑ |
18. Combustion engine equipment placed outside and away. | ☑ |
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| 9. No ingress of water, gas, oil, chemical expected. | ☑ |
19. Entry / exit tracking register (F-19C) maintained by attendant. | ☑ |
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| 10. Connected pipelines/energy sources isolated/locked/blinded. | ☑ |
20. Permit will be displayed near the confined space entry point. | ☑ |
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| STEP 4: GAS READINGS & PERMISSIBLE LIMITS | |||
O2[ GAS_O2 ]20.6 - 21.0% |
LEL[ GAS_LEL ]< 1% |
CO[ GAS_CO ]< 25 PPM |
H2S[ GAS_H2S ]< 5.0 PPM |
| STEP 5: PPE / 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 |
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| STEP 5: JOINT INSPECTION / AUTHORISATION | ||
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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: |
| STEP 6: SPECIAL INSTRUCTIONS / MUKADAM 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, communication failure, change in job scope, hot work in adjacent space, or after any emergency alarm. Mukadam acknowledgement: I have read, understood and explained these instructions to all workers. Signature: _____________________ Date: 2026-08-10 |
| STEP 7: 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 |