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  • SA 924 4 Green Print

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    Abdus Samad
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    This document is a confined space entry permit that outlines the work location, hazards identified, and safety precautions required for entry. It identifies the plant, confined space, work to be done, isolation methods used, potential exposures, and protective equipment required. The permit must be authorized by supervisors and can be renewed or closed once work is complete and the site returned to a safe condition.

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    This document is a confined space entry permit that outlines the work location, hazards identified, and safety precautions required for entry. It identifies the plant, confined space, work to be done, isolation methods used, potential exposures, and protective equipment required. The permit must be authorized by supervisors and can be renewed or closed once work is complete and the site returned to a safe condition.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    203 views2 pages

    SA 924 4 Green Print

    Uploaded by

    Abdus Samad
    This document is a confined space entry permit that outlines the work location, hazards identified, and safety precautions required for entry. It identifies the plant, confined space, work to be done, isolation methods used, potential exposures, and protective equipment required. The permit must be authorized by supervisors and can be renewed or closed once work is complete and the site returned to a safe condition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    CONFINED SPACE ENTRY PERMIT

    Saudi Aramco 924-4 (08/14) Front No. D



    Complete this form in English and write clearly. Use ink pen, not pencil.

    Section 1 – Work Description


    Month ........................................ Day ........................................... Year .......................................... Duration ....................................
    A. Identify plant/facility where the work will be done: ………………...............................…......................................................................................................................................................................................................
    B. Exact work location/confined space to be entered: ………………...............................…........................................................................................................................................................................................................
    C. Work to be done: ………………...............................…....................................................................................................................................................................................................................................................................

    STOP WORK if job site does not meet work permit conditions and any applicable Saudi Aramco safety and health requirements at any time.

    Section 2 – Hazard Identification & Control Section 3 – Gas Testing/Monitoring


    Periodic monitoring required: Yes No If yes, attach a supplemental form. Gas testing frequency: ..............................
    A. Identify and attach any supplementary forms required to perform/control the work:
    Additional gas tests required prior to entry, after breaks/interruption of work, if site conditions change, and at periodic intervals (as required).
    Confined Space Entry Plan (mandatory) Confined Space Entry Log (mandatory)
    Record below or use a supplemental form.
    Job Safety Analysis Gas test records Isolation plan Blind list
    ONLY CERTIFIED GAS TESTERS PERFORM GAS TESTS
    Excavation Checklist Hydrotest procedure(s) Other ………………...............................…
    LEL (%) H2S (ppm) O2 (%) CO (ppm) Others (name/value) Badge No. Signature
    B. Energy Types:
    Hydrocarbon/gas/steam/chemicals Mechanical Electrical Initial Test
    Hydraulic/pneumatic Potential energy (spring loaded, gravity)
    Renewed
    Automated extinguishing systems Other ………………...............................…
    C. Isolation Method(s): Additional
    Locked switch/breaker Mechanical block Blinding Disconnect
    Additional
    Positive isolation (blind or disconnect) shall be used for all piping connections to the confined
    space.
    D. Potential Exposures: Section 4 – Permit Authorization & Closure
    Additional approvals per GI 2.100 or local instructions:
    High noise level Hydrogen Sulfide (H2S) Flammable liquids/gases
    Hazardous/toxic materials Radioactive materials Temperature Other ……….......… Signature: ............................................... Position: ................................................ Date: ..................... Time: ......................
    E. Protective Equipment: Receiver Org.: Issuer Org.:
    Personal H2S monitor FRC Goggles/face shield Chemical suit/overalls
    Fall protection Barricades/warning signs Mechanical ventilation/blower PERMIT Badge No. Cert. No. Signature Badge No. Cert. No. Signature
    Respiratory protection (Explain further in Additional Safety Precautions below) Open
    F. Confined Space Entry Supervisor (CSES) Badge No. ……………..…….......................
    This permit is renewed Date: Duration:
    G. Confined Space Entry Standby Man Badge No. ……………..…….......................
    H. List any Additional Safety Precautions: ………………………………………............................... Renewed

    ....................................................................................…....………………………………...........…....... This permit is closed Date: Time:


    ……………….……………………………………....................................................................................
    I HAVE INSPECTED THE WORK SITE AND CONFIRM THAT IT HAS BEEN RETURNED TO A SAFE CONDITION.

    IN AN EMERGENCY: Closed
    CONFINED SPACE ENTRY PERMIT
    Saudi Aramco 924-4 (08/14) Reverse PERMIT INFORMATION
    HAZARD ANALYSIS CHECKLIST

    Y N N/A Y N N/A

    Is the correct type of permit(s) issued for the work? Is the system/equipment properly isolated and locked out? Did all workers apply their personal locks?
    Have the Job Safety Analysis (JSA) and other applicable supplementary forms been
    Has the system/equipment been depressurized, drained and/or purged before opening it?
    communicated to the work crew?
    Are weather conditions (e.g., wind speed) acceptable to perform the work? Has the potential for releasing flammable liquids and gases been controlled?
    Are slip and trip hazards controlled? Are all ignition sources eliminated or controlled?
    Does the work crew have the correct tools/equipment for the job? Are they in good
    Does the fire watch have firefighting equipment readily available and know how to use the equipment?
    condition?
    Do personnel have the proper certifications to perform the activity and/or operate the Has the potential for exposure to high noise levels, H2S, hydrocarbons, asbestos, hazardous chemicals or
    equipment? radioactive materials been controlled?
    Is the equipment’s inspection sticker valid? Is the correct personal protective equipment (PPE) available for use by personnel?
    If the work may impact others nearby, or vice versa, have the work crews discussed their activities with
    Have all requirements for working at heights (i.e., fall protection) been applied?
    each other (i.e., simultaneous operations [SIMOPS])?
    Is the scaffold tag completed correctly, signed and with a valid inspection date? Is there an emergency contingency plan in place to respond to the work being performed?
    Has the potential for contact with sharp objects, rotating equipment, hot/cold surfaces or live Does the work crew know what to do in the event of an emergency, such as evacuation routes, location
    electricity been eliminated? of emergency equipment and where assembly areas are located?

    Any ‘N’ (NO) answers above shall initiate a “STOP” point where the Issuer and Receiver are to analyze the hazard(s) and develop methods to adequately control the hazard(s) and list the additional precautions on the permit.

    Signatures: Issuer or Designated Representative ………………………..……………….…....................... Receiver ………………………..……………….….......................

    GAS TEST INFORMATION TABLE PERMIT AUTHORIZATION & CLOSURE

    Any reading above 0% LEL No hot work allowed


    Signatures: The Issuer and Receiver complete and sign the front of the permit (Section 4) once the Hazard Analysis
    Combustible Gases/Vapors 5% LEL – 10% LEL Breathing apparatus must be used has been completed and all specified hazard controls are in place, required gas tests recorded, and supplemental forms
    10% LEL or above No work (or confined space entry) allowed attached. Additional signatures are required for extended permits or when gas tests are at levels indicated in the Gas
    10 ppm or above Breathing apparatus must be used
    Test Information Table.

    Hydrogen Sulfide (H2S) 10 ppm – 100 ppm Division Head must sign the permit Renewed Permit: Requires signatures of the Issuer and Receiver coming on shift.
    100 ppm or above No work (or confined space entry) allowed
    Extended Permit: Requires signatures of the Division Head (or above) of both the issuing and receiving organizations.
    Breathing apparatus must be used and Division
    Less than 20.0% Closed Permit: The Issuer and Receiver must sign the work permit after completion of the work or when the permit
    Oxygen (O2) Head must sign the permit
    duration has expired.
    Above 23.5% No work allowed
    35 ppm – 1,000 ppm Breathing apparatus must be used For additional information on the Saudi Aramco Work Permit System, refer to GI 2.100
    Carbon Monoxide (CO)
    1,000 ppm or above No confined space entry allowed

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