Professional Documents
Culture Documents
FOR:
28/02/2012
WorkToBeDone:
CHECKANDDISMANTLETRAVELLINGBEARING
ShutdownInservice
Confined Space Access?
Yes No
Permit No:
AssessorName:
WorkPeriod:8Hours
1.BAGUS
3.
Date&TimeStart
:28/02/201208:00
2.ShiftSPV
4.
Date&TimeFinish
:28/03/201316:00
Rangeofmethodsbywhichworkcouldbedone:
Method1
SHUTDOWNGANTRYCRANE,DISMANTLINGTRAVELLINGBEARING.
SelectedMethod
Detailanyworktobeperformedoutsidetheworkarea/spacethatmaycreateariskto
personnelwhilsttheyarewithintheworkarea/spacee.g.vehicle/stationaryenginefumes,
maintenanceactivities.N/A
Emergency procedures:
Station Emergency Procedures
Special Procedures as attached
HAZARDS IDENTIFIED
RISK
Hazardous Substances
Chemical Contaminant
Chlorine
Ammonia
Ozone
Carbon Monoxide
Carbon dioxide
Hydrogen Sulfide
Dust
Sulfur dioxide
YES
NO
YES
NO
PI-05-03-01-F01
HAZARDS
Flammable Contaminants
Coal
Hydrogen gas
Fuel Oil
Lube Oil
RISK
YES
NO
YES
NO
FOR:
28/02/2012
HAZARDS IDENTIFIED
RISK
HAZARDS
YES
NO
Fire Class
Class A: common combustible ( wood, paper, etc )
Class B: Flame able liquid and gas (gasoline,
Ignition Sources
Work Environment
Lighting
Heat
Humidity
Cold
Slippery Surfaces
Traffic (Pedestrian)
Height/Falls
Other
Manual Handling
Environmental Impact
Entrapment
YES
NO
RISK
YES
NO
YES
NO
CONTROL MEASURES
Safety Helmet
Safety Shoes
Eye Protection
Hearing Protection (ear muff/ear plug)
Welding Mask
Leather apron/gauntlet
Leather gloves
Dust Mask
Rubber Gloves
Rubber apron
Safety boot for chemical
Safety Goggles
Safety harness
Self Contain Breathing Apparatus (SCBA)
PI-05-03-01-F01
FOR:
28/02/2012
The following tests are required to assess the atmospheric conditions within the nominated
space:
Test For
Relative Vapor
density to air
Station Standard
Test Required
(thick selection)
Yes
No
Ammonia
Carbon Dioxide
Carbon Monoxide
Chlorine
Hydrogen Sulfide
LEL
Lessthan5%
Oxygen
Lessthan23.5%
Ozone
Sulfur dioxide
NOTE: For clarification on the test required to be carried out refer PI-05-03-02 (Testing Of
Confined Spaces)
Signature:
( BAGUS WS )
PI-05-03-01-F01
) (
) (
Uncontrolled Copy if printed or copied
FOR:
28/02/2012
Applicant
Date
PI-05-03-01-F01
Shift Supervisor
: 28/02/2012
Time
: 09:00