SAUDI ARABIAN OIL COMPANY

(sAUDr ARAMCO)

Page 15 of 18
OPERATION INSTRUCTION MANUAL

KHURATS PRODUCING DEPARTMENT Gonfined Space Entrv

SAFETY OIM NO: 110.004

Supplement # 3 Confined Space Entry Checklists

Confined S Checklist
VesseVEquipment/Confi ned Space ID: Entry Date:

# Reouirement Yes N/A

1. Confined space entrv procedures/instructions provided and available
2 Area barricaded and has warninq signs posted
3. Electrical sources isolate
4. Process pipinq/eq uipment isolated
5. Hvdraulic/oneumatic and other energy sources isolated
6. Lockout and hold tao orocedures followed
7 HoUcold work permit completed
q_ i conrineo slege e!q{_-Lelrn{_998p!g!gq l_-_,
9. E-:xvqen(ca
10 Atmosphere tested %LEL
11 Atmosohere tested for hvdrooen sulfide (H2S)
12. Atmosphere tested for other qases (e.q., CO),identify:
13. Gases/chemicals purqed, flushed, vented
14. Continuous qas testinq performed
15. Mechanical ventilation provided
16. Aooropriate personal protective equipment (PPE) provided and used
17. Aoorooriate resoirator(s) (e.q.. SCBAs) provided and used
18. Full-bodv harness provide and used by each entrant
19. Aoorooriate liohtino eouioment provided
20. Rescue serviee notified of confined space entry operations
21. Rescue eouioment (e.q.. hoist) available
22" Fire extinquisher(s) available at designated entry points
23. Standbv man continuouslv present during confined space entry
24. Standbv man has necessary PPE
25. Communications equipment for standby man and entrants provided
zo" Entrv loo sheet available at designated entry points and used

Remarks:."..

@adge*|ReceiverName,Signature,Badge#|Time/Date:

Note: This checklist shall be completed by the Work Permit lssuer and Receiver during their joint site
inspection prior to signing each work permit and before allowing confined space entry. The completed
checklist shall remain with the Confined Space Standby Man on site after the joint site inspection is
complete
SaudiAramco: Company General Use

lssued: OgllUzA14 R.eplaces: 4il0712413

SAUDI ARABIAN OIL COMPANY
(SAUDIARAMCO) Page {1 of 18
OPERATION INSTRUCTION MANUAL

Khurais Producinq Department Confined Snace Entrv

Snrgty OIM NO: 110.004

Operations Supervising Operator Signature :

Badge No.:

SaudiAramco: Company General Use

lssued: 0911012CI14 Replaces: 0510712013

SAUDI ARABIAN OIL COMPANY
(SAUDIARAMCO) Page 10 of {8
OPERATION INSTRUCTION MANUAL

Khurais Producing Depatf,nent Confined Space Entrv

SAFEry OIM NO: 110.004

Attachment # 1 Gonfined Space Gas Tests Log

AKNOWLEDGEMENT OF
STANDBY MAN,S RESPONSIBILITIES
The standby man will be responsible for:
1. Maintaining ;ommunication with employees in the confined space.
2. Accounting ior personnelworking in the confined space.
3. Preventing fouling of air line or lifelines.
4. Providrng assistance in handling material, tools, message, etc.
5. Being alert for potential hazards both inside and outside the confined space"
6" CallinU for assistance if an emergency develops.
7. Evacuating personnel if necessary.
8. Ensr"rring the Confined Space Entry Log is maintained.
9. Being knowledgeable in the operation and use of the required safety and
rescue equipment"
10.Tl"e rtandby' man must never leave his position while personner are ir, tre
i . ,. .. le. . ;:piti,ri

AKNOWLEDGEMENT
I acknowledge that I have read the Standby Man's
Responsibilities as set forth above. I also understand that I have been designated as the
Standby Man and I accept these responsibilities untii my Supervisor has relieved me of
my duties"

Employee's Signature:
Badge Number:
Date:
Time that duty begins:
Time that duty ends:

Receiver Supervisor Signature.

Badge No.:

SaudiAramco: Company General Use

lssued: 0911012014 Replaces: OSl07l2Q13

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