Confined Spaces 

n 

any special instructions and/or safety measures to be included on the 

Permit to Work 

n 

the expected date on which the work is to commence and duration or 

the task 

n 

a schematic diagram of the isolation, venting and testing 

arrangements (if applicable) 

n 

the sequence of operations to be undertaken indicating: 

n 

the location at which each operation is to be performed 

n 

the identity of each valve or component part to be operated 

n 

the operation to be performed 

n 

the reason for the operation 

n 

testing and monitoring of the atmosphere 

n 

any item (e.g. keys, locks, signs) or other Permit to Work 

required 

n 

method of communication, emergency procedures and rescue 

arrangements 

n 

standard caution to entrants   at first sign of dizziness, eye irritation, 

headache, pulsing of the temples or nausea, vacate the confined space 

n 

the name and signature of the author and Authorised Person 

approving the method statement 

5.2.5  

The approved Safety Method Statement is to be placed in a folder marked 

 Safety Method Statements  and retained in the Confined Space 

Document Cabinet.  The Safety Method Statement should be cross 

referenced to the corresponding Permit to Work. 

5.2.6  

The designated Person in Charge is to be issued with a copy of the Safety 

Method Statement for the purpose of ensuring the work identified is 

carried out in accordance with the agreed safe method of working. 

5.2.7  

The Authorised Person is to use a copy of the Safety Method Statement for 

the purpose of checking the isolation arrangements and that the agreed 

safe method of working is being followed. 

5.2.8  

When the sequence of isolation operations detailed on the Safety Method 

Statement is being carried out prior to the issue of the Permit to Work, the 

Authorised Person is to note the date and time of each operation and keep 

a record on file with the approved Safety Method Statement. 

April 2005 

35