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Does the task require a permit or other document approval? NO YES Indicate which
Build barrier & clear tank People falling in hole before barrier Have barrier in place if possible before YES
complete, clearing gases may be toxic opening tank, test air coming out & be
prepared for foul air/fluid.
Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy
Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy
Entry No Contact with the Entrant Place a Standby Person at manhole to YES
maintain contact with the entrant and
record entry / exit.
Dark / Insufficient Illumination Ensure safe illumination suitable
t o h a z a r d o u s a r e a classification
Fire & Explosion Ensure the work to be carried out
i n s i d e t h e C o n f i n e d Space fulfill the
Permit to Work requirement for the type
of work.
Heat & Humid Ensure sufficient ventilation a
nd air circulation inside
confined space
Provide periodic break / rest to the
entrant
Toxic Hazard Ensure continued gas monitoring.
Ensure cross ventilation to dispose toxic
vapor.
Entrapment or Collapse of Entrant Ensure availability of full body
harness & lifeline etc for emergency
retrieval of personnel from Confined
Space.
Re-entry /Completion Left Unattended for Re-Entry Barricade the Confined Space and post YES
warning notice.
Foreign Materials Left inside Ensure there is no tool, equipment, rags
or other materialleft inside
Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy
Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy
Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy