Ramsis Engineering

Confined Space Rescue Preplan

Designation of Rescue Personnel:
 First Responder(s)_______________________________________________
 Team Leader _______________________________________________
 Safety Line(s) _______________________________________________
 Backup Rescuer(s)_______________________________________________
 Riggers(s) _______________________________________________
 Attendant _______________________________________________
 Others _______________________________________________

Space Description:

Sketch or diagram of space: (Use another sheet and attach)

Entry Supervisor name: Phone no: Date:

Report Completed by:

Prepared by: Reviewed by: Approved by:

Mahmood AbdulAziz Rishaad Sadek

HSE Superintendent HSE Manager

 Ramsis Engineering
Confined Space Rescue Preplan
Date:

Space Designation: Space Location:

Space Category: Space Type:

□ Category I – Rescue Available (RA) Elevated: Y N
□ Category II – Rescue Standby (RS) Congested: Y N
Deep: Y N
Means to Summons Rescue Service:
□ Phone □ Pager □Radio □ Audible Signal □ Others

Method of Rescue
□ Confirm that attendant has been trained in Emergency Response Procedure

□ External (Retrieval) □ Internal: ___________________ Congested: _________________

□ Hauling System Required □ Victim Lowering System Required / Lowering Area: ____________

□ Anchorage: Overhead_______ □ Pre-rigging required? □ YES □ NO

Anchorage: □ Beam □ Welded steel hand rail □ Support Strut □ Other Workers
□ Stairwell □ Anchored steel pipe □ Support column

Rescue Equipment Requirements: (Indicate quantity needed)

Hauling System Carabiners Pulleys

Ascenders Shock Absorbers Anchor Straps

Webbing Rigging Bags BA set
Escape Mask Head Torch Safety Harness & Rope
Rescue Rope Needed: (Indicate Quantity Needed)

Main Line(s) Hauling Systems Lowering Line(s)

Safety Line(s) Transfer System Line(s) Others____________

Medical & Packing Equipment Needed: (Indicate Quantity)

Spinal Mobilization Device: Stretcher Device:

C-Collar Medical Kit

Additional PPE: (See Permit or MSDS)