Form E618 "Confined Space Safety Checklist and Entry Permit" - Canada

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CONFINED SPACE SAFETY CHECKLIST AND ENTRY PERMIT
SHIPBOARD CONFINED SPACE ENTRY PROCEDURES:
The procedures apply to all customs personnel involved in shipboard confined space examination. It is not discretionary and should not be treated as such. It is
mandatory that the procedures be adhered to at all times. Strict compliance is essential to maintain a high level of safety.
DEFINITION OF A CONFINED SPACE:
Means an enclosed or partially enclosed space that
a) is not designed or intended for continuous human occupancy except for the purpose of performing work,
b) has restricted means of access and egress, and
c) may become hazardous to a person entering it due to
(i) its design, construction, location or atmosphere
(ii) the materials or substances in it, or
(iii) any other conditions relating to it;
HAZARDS ASSESSMENT AND PRE-ENTRY VERIFICATION:
Before entering a confined space, the Confined Space Safety Checklist and Entry Permit - form E-618 must be completed and signed by all team members.
EMERGENCY PROCEDURES
Vessel construction, risk factors and entry environments differ in virtually all cases. Despite the hazards assessment and the pre-entry verifications, the
assumption must remain that there are hidden hazards. The entrant must continuously proceed catiously and not proceed any further where he believes he can
be injured and/or cannot be rescued. The team's emergency preparedness is to remain high at all times.
DEPARTMENTAL SAFETY – ENTRY INTO CONFINED SPACES
The atmosphere in any confined space may be incapable of supporting human life. It may be lacking oxygen content and/or contain
flammable or toxic gases. This also applies to tanks which have been inerted.
Before entry into cargo tanks, pump rooms, fuel tanks, cofferdams, duct keels, ballast tanks, cargo holds, and similar enclosed or
confined spaces, an assessment must be made by the attendant in conjunction with the master or responsible officer.
GENERAL PRECAUTIONS
WARNING
Do not enter any such space unless authorized by the master
When the atmosphere in the space is unsafe or suspect,
or the responsible officer and unless the appropriate safety
it should never be entered to conduct an examination.
procedures laid down for the ship have been carried out. The
Escape or breathing apparatus must never be used in
checklist on the reverse side of this sheet must be used
such circumstances.
whenever examination of a confined space is to take place.
The attendant, together with the master or responsible officer
PROTECTIVE EQUIPMENT AND CLOTHING
MUST determine that it is safe to enter a potentially
All persons entering enclosed or confined spaces should
dangerous space by ensuring that:
wear suitable clothing and make use of protective equipment
(a) the space has been properly ventilated by natural or
provided. Access ladders and surfaces within the space may
mechanical means; and
be slippery and suitable footwear should be worn. Safety
(b) the atmosphere of the space has been tested with
helmets protect against falling objects and bumps. Safety
appropriate instruments at different levels for
harness/lifelines must be used on all applicable occasions.
acceptable levels of oxygen and/or other gases.
E618 E (04)
- 1 -
(Ce formulaire existe aussi en français.)
CONFINED SPACE SAFETY CHECKLIST AND ENTRY PERMIT
SHIPBOARD CONFINED SPACE ENTRY PROCEDURES:
The procedures apply to all customs personnel involved in shipboard confined space examination. It is not discretionary and should not be treated as such. It is
mandatory that the procedures be adhered to at all times. Strict compliance is essential to maintain a high level of safety.
DEFINITION OF A CONFINED SPACE:
Means an enclosed or partially enclosed space that
a) is not designed or intended for continuous human occupancy except for the purpose of performing work,
b) has restricted means of access and egress, and
c) may become hazardous to a person entering it due to
(i) its design, construction, location or atmosphere
(ii) the materials or substances in it, or
(iii) any other conditions relating to it;
HAZARDS ASSESSMENT AND PRE-ENTRY VERIFICATION:
Before entering a confined space, the Confined Space Safety Checklist and Entry Permit - form E-618 must be completed and signed by all team members.
EMERGENCY PROCEDURES
Vessel construction, risk factors and entry environments differ in virtually all cases. Despite the hazards assessment and the pre-entry verifications, the
assumption must remain that there are hidden hazards. The entrant must continuously proceed catiously and not proceed any further where he believes he can
be injured and/or cannot be rescued. The team's emergency preparedness is to remain high at all times.
DEPARTMENTAL SAFETY – ENTRY INTO CONFINED SPACES
The atmosphere in any confined space may be incapable of supporting human life. It may be lacking oxygen content and/or contain
flammable or toxic gases. This also applies to tanks which have been inerted.
Before entry into cargo tanks, pump rooms, fuel tanks, cofferdams, duct keels, ballast tanks, cargo holds, and similar enclosed or
confined spaces, an assessment must be made by the attendant in conjunction with the master or responsible officer.
GENERAL PRECAUTIONS
WARNING
Do not enter any such space unless authorized by the master
When the atmosphere in the space is unsafe or suspect,
or the responsible officer and unless the appropriate safety
it should never be entered to conduct an examination.
procedures laid down for the ship have been carried out. The
Escape or breathing apparatus must never be used in
checklist on the reverse side of this sheet must be used
such circumstances.
whenever examination of a confined space is to take place.
The attendant, together with the master or responsible officer
PROTECTIVE EQUIPMENT AND CLOTHING
MUST determine that it is safe to enter a potentially
All persons entering enclosed or confined spaces should
dangerous space by ensuring that:
wear suitable clothing and make use of protective equipment
(a) the space has been properly ventilated by natural or
provided. Access ladders and surfaces within the space may
mechanical means; and
be slippery and suitable footwear should be worn. Safety
(b) the atmosphere of the space has been tested with
helmets protect against falling objects and bumps. Safety
appropriate instruments at different levels for
harness/lifelines must be used on all applicable occasions.
acceptable levels of oxygen and/or other gases.
E618 E (04)
- 1 -
(Ce formulaire existe aussi en français.)
CONFINED SPACE SAFETY CHECKLIST AND ENTRY PERMIT
Before entry into the confined space, the appropriate safety checks listed below must be carried out by the attendant and the entrant, having
first made an assessment of the risk with a responsible ship's officer.
The attendant must ensure that this checklist has been fully completed before the examination commences.
Date permit validated
Time permit validated
Ship name
Location
Area searched
Print name
Signature (Upon completion of all checks)
Attendant
Entrant
Emergency
Officer
Assisting Officer
Date and time of entry into this space
Anticipated date and time of exit
Length of time for which permit is valid
Hazard assessment and identification
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Slips, trips and falls
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fall exceeding 2.4 metre
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Potential presence of Vapours or Flammable gas? (See result Section 1)
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Potential presence of toxic gas? (See result Section 1)
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Potential presence of unacceptable oxygen levels (See result Section 1)
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Potential presence of airborne hazardous substances (e.g., Dust)?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Presence of liquid in which entrant may drown?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Presence of free-flowing solid in which entrant may be entrapped?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Potential entry of liquid, free-flowing solid or hazardous substance?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Material harmful to skin?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electrical Hazards?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Mechanical hazards?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Temperature Extremes?
Yes
No
. . . . . . . .
Other, Specify
- 2 -
SECTION 1
ATMOSPHERIC TESTING
Tested by (Print name)
Time
Multi-gas monitor used
Date of last calibration
Permissible
CO: 0 to 25ppm H2S: 0 to 10ppm
CO: ____________ H2S: ____________
Test
exposure
results
limits
02: 19.5 to 23% LEL: 0 to 10%
02: ____________ LEL: ____________
1% on Tankers
SECTION 2
TO BE CHECKED BY ATTENDANT
Have arrangements been made to have a responsible
Has the space been properly ventilated, tested,
2.1
2.6
person to be in constant attendance at the entrance to
and found safe?
the space?
Have arrangements been made to prevent the entry of
Has a system of communications between attendant and
2.2
2.7
liquid or hazardous substances into the space?
those entering the space, been arranged and tested?
Have arrangements been made to continue ventilation
2.3
2.8
Are access and illumination adequate?
during occupancy of the space and at breaks?
Have arrangements been made to repeat testing at
Are portable lights and other equipment to be
2.4
2.9
regular intervals during occupancy?
used, of the appropriate type?
Are rescue and resuscitation equipment available for
2.5
immediate use at the entrance to the space?
SECTION 3
TO BE CHECKED BY THE ATTENDANT AND EMERGENCY OFFICER
Are you familiar with the breathing
3.1
apparatus to be used?
Has the breathing apparatus been checked as
(i)
Cylinder #1 _________________ psi
Adequacy of air supply -
3.2
follows:
Cylinder #2 _________________ psi
L-1000
_________________ psi
(ii)
Low pressure audible alarm?
(iii)
Have the emergency signals and other
Respirator and Resuscitator - air supply and tightness?
3.3
emergency arrangements been agreed to?
Ships alarms
Emergency telephone no.
SECTION 4
TO BE CHECKED BY ENTRANT
Do you understand the arrangements made for
Are you aware that you should leave the space
4.3
communications between yourself and the attendant?
4.1
immediately in the event of ventilation problems,
communication failure, or if your gas alarm is activated?
Have you been given permission by the attendant to enter
4.4
Are you satisfied that all relevant checks in
the space?
4.2
sections 1, 2 and 3 have been completed?
4.5
Adequacy of air supply for the lifeair 10.
- 3 -
NARRATIVE LOG
CO
H2S
Time
Remarks
O2
LEL
Printed in Canada
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