MEGHMANI ORGANIC LTD.

Permit No: __________

Plant Name Here Additional permit No.:_______
Date:______________

CONFINED SPACE ENTRY PERMIT

A. TO BE FILLED BY ORIGINATOR.
□ Originator______________________________ □ Executing Dept. : ______________________________________
Plant & site location : _____________________________________________________________________
Equipment No. & Location : _____________________________________________________________________
Description & nature of work : _____________________________________________________________________
Name of the agency involved : _____________________________________________________________________
Validity : From:-____________ Hrs to ___________ Hrs
B. HAZARD ASSESSMENT AND PRE-WORK SAFETY MEASURES
B1. TO BE CHECKED BY CONCERNED PLANT.
Equipment earlier used for Material (Mention last Content):____________________________________
Hazard associated with last content: □ Flammable □ Toxic □ Corrosive □ Oxidizing
□ Water Reactive □ Others______________
Expected Hazards : □ Toxic gas release □ Fall in to depth □ Fire/Explosion □ Chemical exposure □ Asphyxiation /Oxygen
deficiency □ Burns due to high Temperature □ Burns due to low Temperature □ Rotating Part □ Electrical Shock
No /
Precautions Yes If NO/NA, tell why?
NA
1. Has Equipment been □depressurized, □emptied, □cleaned, □washed □Cooled to room
temperature? Cleaned /flushed with □ water □ steam □ nitrogen □ Air □
Other(Specify)_________
2. Have all pipelines (Process & Utility) connected to the equipment been effectively
□disconnected □ blinded □isolated? (Use marker blind of proper rating.)
3. Has 24 volt portable flame proof lamp been provided for proper lighting inside the equipment ?

4. Ventilation Measures : □ Natural ventilation □ Forced ventilation by :

Location of suction for Forced Ventilation:
For Negative ventilation bottom valve is closed ?
If above are not possible & needed use of Online Air respirator be used
5. Stand by Observer: I have been assigned the responsibility of stand by observer and have been given necessary instructions.
Sign : _____________________ Name : ______________________Date : ________________ Time : ___________Hrs
Relieved by : Sign : ________________ Name : ______________________Date : ________________ Time : ___________Hrs
6. Have following Personal Protective Equipment’s been provided? (Tick mark the item required )
□Airline respirator □ Gas Cartridge mask.□ Full Body Harness □ P.V.C. Suit. □ Face shield □
Goggles □ Suitable Hand gloves (_______________ ) □ Helmet □ Safety shoes □
Other(specify) _______________________
Is life line properly Anchoring at outside of Equipment? Use rope ladder /suitable ladder
7. ELECTRICAL ISOLATION :
□ Equipment □ Machine no. __________ has been electrically isolated
through General work permit No. _____________
Has Agitator push button trial been taken for ensuring of not working of agitator? Fix Do not
Operate tag on push button.
Shift In-charge: I have personally checked the above arrangements to be correct and certify that the isolation has been provided after complete
assessment so that no inadvertent operation can occur
Sign : _____________________ Name : ______________________Date : ________________ Time : ___________Hrs
Relieved by : Sign : ________________ Name : ______________________Date : ________________ Time : ___________Hrs
I have personally checked the above arrangements and found correct.
Sign : _____________________ Name : ______________________Date : ________________ Time : ___________Hrs
□ H.O.D (Concerned dept.)

 If anything unexpected happens, stop work immediately and notify the shift in-charge/ Plant HOD
Important  In case of Emergency siren; stop work and bring job to safe mode immediately and follow On-site Emergency Plan
B2. TO BE CHECKED BY EXECUTING DEPT:
8. Have Provisions made by concerned □ plant □ Dept. been checked & found acceptable for the
work?
9. Name & Signature of persons entering in Confined Space after Tool Box talk.
Name : 1)______________________2)_______________________3)____________________
Sign : 1)______________________2)_______________________3)____________________

I have personally checked the above arrangements and found correct.

Sign : _____________________ Name : ______________________Date : ________________ Time : ___________Hrs
□ H.O.D. / Engineer (Executing dept.)
B3. TO BE CHECKED BY SAFETY DEPT:
13. Have Provisions made by concerned□ plant □ Dept. & □Originator □ Executing Dept. been
checked & found acceptable for the work?
14. Is Oxygen content inside the Equipment found above 19.5 %?
Oxygen : ___________ % Time of checking _______________
15. Is Equipment checked for absence of toxic gases by Odour testing? Time of checking
_______________
16. Have□ Equipment □ work area been checked for absence of solvents & flammable vapours?
LEL : _______________ % Time of checking _______________
I have personally checked the above arrangements and found correct
Sign : _____________________ Name : ______________________Date : ________________ Time : ___________Hrs
□ Safety Officer
B4. REMARKS IF ANY:
___________________________________________________________________________________
___
______________________________________________________________________________________

C. EXTENSION OF PERMIT:
All the permit conditions have been rechecked and the permit is extended.

Request for Extension up to time _________Hrs by (Department, Name & Signature) _______________________________________________

Request for Section B Extension may be Section B3 Extension Approved Extension Accepted
extension. rechecked and given rechecked and Head-Safety/ HOD – Executing Engineer/
(HOD-Exec. certified HOD (Concerned Certified HSE (G Shift) HOD
Dept.) Shift In-charge plant) (Safety Officer) Unit Head (For
(Concerned plant) Beyond G Shift)
Date: □Yes □No □Yes□ No □Yes □ No □Yes □No □Yes □ No
Sign:__________ Sign:__________ Sign:__________ Sign: _________ Sign: _________ Sign:__________
Name:_______ Name:_______ Name:_______ Name:_______ Name:_______ Name:_______
Time : ________ Time : ________ Time : ________ Time : ________ Time : ________ Time : ________

Date From To (Hr’s) Name & Sign of Name & Sign of HOD Name & Sign of HOD/ Name & Sign of Safety
(Hr’s) Shift In-charge Concerned plant. Engineer (Executive dept.
department.)
O2% ___ LEL%____
Sign Time
_______ _________

C. POST-WORK SAFETY MEASURES

C1. COMPLETION OF WORK :

HANDED OVER BY: TAKEN OVER BY:

It is certified that
□ All tools removed, equipment inspected and declared OK
□ All blinds removed and isolations restored
□ All Guards placed back
□ Equipment Earthing / Earthing jumpers provided back on pipeline,
□ All tools removed, equipment inspected and declared OK
□ All blinds removed and isolations restored
□All Guards placed back and found OK
□ Equipment Earthing / Earthing jumpers provided back on pipeline,
 if applicable
□ Flange guard provided back on pipeline, if applicable
□ Housekeeping done
Remarks:
________________________________________________________
________________________________________________________
Sign.:____________________ Name : _________________________
if applicable
□ Flange guard provided back on pipeline, if applicable
□ Housekeeping done satisfactory
Remarks:
_________________________________________________________
_________________________________________________________
Sign.:_____________________ Name : _________________________

Dept.:______________ Date:_____________ Time :________Hrs Dept.:______________ Date:_____________ Time :________Hrs

NOTE 1:
RESPONSIBILITY OF STAND BY OBSERVER:

i) Observer will maintain an accounting of all entrants in the confined space at all times.
ii) Observer will be knowledgeable of and will be able to recognize potential confined space hazards, and monitor activities inside
and outside the space to determine if it is safe for entrants to remain in the space.
iii) Methods of communication will be established so that the attendants can maintain effective and continuous contact with during
entry, and order individuals in the confined space to immediately evacuate for any of the following reasons:

(1) The Observer observes a condition, which is not allowed in the entry permit.
(2) The Observer detects behavioral effects of hazard exposure.
(3) The Observer detects a situation outside the space, which could endanger the entrants.
(4) The Observer detects an uncontrollable hazard within the permit space.

iv) The Observer must not leave to focus attention elsewhere.

v) Each Observer will be knowledgeable of the site emergency procedures, including notifying of an emergency and sounding the
plant alarm systems, which will summon rescue and other emergency services as soon as a determination is made that entrants of
a permit space need to escape.
vi) The Observer will keep all un-authorized personnel away from the confined entry space.
vii) The Observer will not be authorized to enter the confined space to initiate a rescue, but will be knowledgeable of action to be
taken to ensure the protection from hazards outside the entry space during an emergency involving the space.

NOTE 2:
1) Hot Work Permit is to be followed in case of hot work at the confined space.
2) Violation of any of the above precaution will be treated as a cancellation of the permit.
3) This permit is not valid in case of emergency. In that case, stop the work in safe mode and follow onsite emergency plan.
4) The First issue of permit is to be in duplicate, 1st copy should be with executing department for display at work site while 2 nd copy is that of
safety dept. whenever renewal is required, authorization is to be taken in 1 st copy.
5) After completion of the work, 1st copy of permit is to be given to Originator Plant/Department who in turn will give to safety dept .

Tool Box Talk : Topic _______________________________________ Given By Name & Sign______________________________

Sr. Name Company E. code / Signature Sr. Name Company E. code / Signature
No. Contract Name No. Contract Name