€¦ · Web viewPermit-Required Confined Spaces. Responsible Person(s) Assignment of Responsibility. Employer. Program Manager. Entry Supervisor(s) Attendant(s) Entrants / Affected

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Confined Space ProgramTable of Contents

I. Overview A. PurposeB. Characteristics of a Confined SpaceC. Examples of Confined SpacesD. Risks InvolvedE. Confined Spaces in the WorkplaceF. Permit-Required Confined SpacesG. Responsible Person(s)

II. Assignment of Responsibility A. EmployerB. Program ManagerC. Entry Supervisor(s)D. Attendant(s)E. Entrants / Affected EmployeesF. Rescue Team

III. Training A. General TrainingB. Specific Training

IV. Identification of Hazards and Evaluation of Confined Spaces A. SurveyB. Hazard ReevaluationC. Pre-Entry Job Hazard Assessment (JHA)D. Hazard Controls

V. Entry Permits A. Key Elements of Entry PermitsB. Permit Scope and Duration

VI. Entry Procedures A. Prior to EntryB. Opening a Confined SpaceC. Atmospheric TestingD. Isolation and Lockout/Tagout SafeguardsE. Ingress / Egress SafeguardsF. Warning Signs and Symbols

VII. Emergency Response A. Emergency Response PlanB. Retrieval Systems and Methods of Non-Entry Rescue

Appendix:

1. Confined Space Entry Permit (Example) – Pages 12-152. Confined Space Entry Training Log (Example) – Page 16

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I. OVERVIEW

A. Purpose The purpose of this program is to establish safety policies and procedures that will control the risks associated with Confined Spaces so that employees can work safely in them. COMPANY NAME will provide and adhere to safety requirements as documented within this program. Additional reference: Occupational Safety and Health Administration’s (OSHA) Confined Space Standard, 1910.146.

B. Characteristics of a Confined Space A confined space is an area that is large enough for workers to enter but may have a limited or restricted means of ingress and egress (entry and exit). It is not designed for continuous human use.

C. Examples of Confined Spaces Boilers, Tanks, Silos, Reaction Vessels, Vats, Degreasers, Pits, Basements, Attics, Crawl Spaces, Vent & Exhaust Duct, Underground Vaults, Manholes, Sewers, Pipelines, Tunnels, Ship Compartments, Grain Storage Bins

D. Risks Involved i. There is a potential for hazardous atmospheres that will not support human life such as

a lack of oxygen (oxygen level is below 19.5%), a flammable atmosphere (fire & explosion), an atmosphere containing a hazardous chemical (hydrogen sulfide, carbon monoxide, or other chemicals)

ii. There is a potential for being engulfed such as in grain bins especially with sloped sides that lead to a small opening.

iii. There is a potential for drowning due to hitting pipes that contain high pressure liquids that could fill up the confined space if accidentally contacted.

iv. There is a potential for electrocution due to working on metal in a conductive environment.

v. There is a potential for falls especially on to unsafe objects such as protruding pipes.vi. There is the inability to safely egress due to the manhole openings on some of these

confined spaces.

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E. Confined Spaces in the Workplace All confined spaces in COMPANY NAME’s workplace will be assessed and identified by Confined Space Danger signs. DESIGNATED INDIVIDUAL will write safety plans for working in each of the Confined Spaces identified so that the above risks are controlled and COMPANY NAME‘s employees are protected. Prior to entering the Confined Space, DESIGNATED INDIVIDUAL will complete a Job Hazard Assessment prior to entrance to any Confined Space to ensure that all risks are controlled prior to entry.

F. Permit-Required Confined Spaces A permit-required confined space is a high hazard confined space that has the potential to:

i. Contain a hazardous atmosphere.ii. Engulf an entrant.iii. Entrap an entrant (such as sloped walls to a smaller hole).iv. Contain risks that could seriously injure employees.

G. Responsible Person(s) The responsible person(s) for COMPANY NAME is/are DESIGNATED INDIVIDUAL(S).

II. ASSIGNMENT OF RESPONSIBILITY A. Employer

In administering this Confined Space Program, COMPANY NAME will:i. Provide a responsible person for managing the program.

ii. Provide atmospheric testing equipment and other safety equipment as needed.iii. Provide personal protective equipment as needed.iv. Provide training to all affected employees and supervisors.v. Review the program on at least an annual basis to determine if additional hazards exist

or if the program is adequate.

B. Program Manager DESIGNATED INDIVIDUAL is responsible for managing the Confined Space Program. The Program Managers duties are to:

i. Maintain a list of confined spaces at all worksites.ii. Create a Confined Space Entry Plan for each distinctive confined space so that all noted

risks are addressed with proper control measures.iii. Ensure proper training of all required personnel is conducted and documented. All

affected personnel must understand the risks of each confined space and the control measures necessary to prevent accidents.

iv. Coordinate with outside responders if necessary.v. Ensure that safety equipment complies with standards.vi. Periodically observe Confined Space Entry Procedures to ensure that the Entry

Supervisor, Attendants, Entrants, and Rescue Team are doing their job.

C. Entry Supervisor(s) The Entry Supervisor(s), will be qualified and authorized to approve confined space entry permits. The Entry Supervisor(s’) duties are to:

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i. Determine if conditions are acceptable for entry – this includes ensuring that all noted Confined Space Entry requirements that have been established by the Program Manager have been met and observing the confined space for any additional hazards that need to be controlled.

ii. Complete and sign the Entry Permit.iii. Ensure ongoing air monitoring is in place and is performed by qualified personnel with

proper equipment.iv. Ensure that the rescue team is ready.v. Post the permit and periodically oversee entry operations as needed, based on risks.vi. Renew the permit each shift.

vii. Terminate entry procedures as required.viii. Serve as an Attendant (if needed), assuming they are trained and equipped

appropriately for that role.ix. Ensure measures are in place to keep unauthorized personnel clear of the area.x. Ensure that necessary information on chemical hazards is kept at the worksite for the

employees or rescue team to review.xi. Ensure cancelled permits are reviewed with the Program Manager for lessons learned.

xii. Ensure all employees are removed and proper closure requirements are met at the end of each shift.

D. Attendants Attendant(s) are employees that are stationed outside of the confined workspace. The Attendant(s’) duties are to:

i. Be knowledgeable of, and able to recognize, existing and potential confined space hazards.

ii. Maintain a sign-in/sign-out log with a count of all persons in the confined space, ensuring all entrants sign in and out.

iii. Monitor surrounding activities to ensure the safety of personnel.iv. Maintain effective and continuous communication with personnel during confined space

entry, work, and exit.v. Order personnel to evacuate the confined space if they:

1. observe a condition which is not allowed on the entry permit;2. notice the entrants acting strangely, possibly because of exposure to hazardous

substances;3. notice a situation outside the confined space which could endanger personnel;4. notice a hazard within the confined space that has not been previously

recognized or taken into consideration;5. must leave his/her work station; or6. must immediately summon the Rescue Team if crew rescue becomes necessary.

vi. Keep unauthorized persons out of the confined space.

E. Entrants/Affected Employees Employees who are granted permission to enter a confined space have a duty to:

i. Read and observe the entry permit requirements;ii. Remain alert to the hazards that could be encountered while in the confined space;iii. Properly use the personal protective equipment that is required by the permit; and

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iv. Immediately exit the confined space when:1. they are ordered to do so by an authorized person;2. they notice or recognize signs or symptoms of exposure;3. a prohibited condition exists; or4. the automatic alarm system sounds.

F. Rescue Team The Rescue Team members have a duty to:

i. Complete training drills using mannequins or personnel in a simulation of the confined space prior to the issuance of an entry permit for any confined space and at least annually thereafter.

ii. Respond immediately to rescue calls from the Attendant or any other person recognizing a need for rescue from the confined space.

iii. Receive the same training as that required of the authorized entrants, in addition to emergency response training.

III. TRAINING COMPANY NAME will provide safety training to all employees that will be involved in the Confined Space Program so that they fully understand the risks involved and how to control them.

A. General Training All employees who will enter confined spaces will be trained in entry procedures. Personnel responsible for supervising, planning, or participating in confined space entry and rescue will be adequately trained in their functional duties prior to any confined space entry.

Training will include:i. Explanation of the general hazards associated with confined spaces and their means of

control. These include:1. atmospheric hazards;2. chemical hazards;3. the need for oxygen levels to be maintained at 19.5% to 23.5%;4. fall hazards;5. electrical hazards;6. mechanical hazards;7. engulfment hazards;8. the lockout and tagout of any connected high-pressure gas or steam lines to the

confined space; and9. draining of pipes containing liquids prior to entry.

ii. Discussion of the specific confined space hazards associated with the facility, location, or operation.

iii. Reason for, proper use of, and limitations of, personal protective equipment and other safety equipment required for entry into confined spaces.

iv. Explanation of permits and other procedural requirements for conducting a confined space entry.

v. A clear understanding of what conditions should prohibit entry.vi. Procedures for responding to emergencies.

vii. Duties and responsibilities of the confined space entry team.Page 5 of 16


viii. Description of how to recognize symptoms of overexposure to probable air contaminants in themselves and co-workers, and method(s) for alerting the Attendant(s).

Refresher training will be conducted as needed to maintain employee competence in entry procedures and precautions.

B. Specific Training i. Training for Atmospheric Monitoring Personnel will include proper use of monitoring

instruments, including instruction on:1. proper use of the equipment;2. calibration of equipment;3. sampling strategies and techniques; and4. exposure limits (PELs, TLVs, LELs, UELs, etc.).

ii. Training for Attendants will include:1. procedures for summoning rescue or other emergency services;2. proper utilization of equipment used for communicating with entry and

emergency/rescue personnel; and3. Confined Space Entry Plans for each confined space to ensure that identified

risks are controlled and potential risks can be recognized.

iii. Training for Emergency Response Personnel will include:1. rescue plans and procedures developed for each type of confined space that is

anticipated to be encountered;2. use of emergency rescue equipment;3. first aid and CPR techniques; and4. work location and confined space configuration to minimize response time.

IV. IDENTIFICATION OF HAZARDS AND EVALUATION OF CONFINED SPACES A. Survey

DESIGNATED INDIVIDUAL will ensure a survey of the facility or jobsite is conducted to identify confined spaces. The purpose of the survey is to develop an inventory of those locations and/or equipment at COMPANY NAME that meet the definition of a confined space. This information will be communicated to personnel and appropriate confined space procedures will be followed prior to entry. The initial surveys will include air monitoring to determine the air quality in the confined spaces.Additionally, the potential for the following situations will be evaluated during the survey:

i. flammable or explosive potential;ii. oxygen deficiency;iii. presence of toxic and corrosive material;iv. electrical hazards;v. fall hazards; andvi. any other noted hazards

B. Periodic Hazard Reevaluation

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DESIGNATED INDIVIDUAL will identify and reevaluate hazards based on possible changes in activities or other physical or environmental conditions that could adversely affect work. A master inventory of confined spaces will be maintained. Any change in designation of a confined space will be routed to all affected personnel by DESIGNATED INDIVIDUAL.

C. Pre-Entry Job Hazard Assessment (JHA) A hazard assessment will be completed by DESIGNATED INDIVIDUAL prior to any entry into a confined space. The hazard assessment will identify:

i. the sequence of work to be performed in the confined space;ii. the specific hazards known or anticipated; andiii. the control measures to be implemented to eliminate or reduce each of the hazards to

an acceptable level.

No entry will be permitted until the hazard assessment has been reviewed and discussed by all persons engaged in the activity. Personnel who are to enter confined spaces will be informed of known or potential hazards associated with said confined spaces.

D. Hazard Controls The following order of precedence will be followed to reduce confined space risks:

i. Engineering ControlsEngineering controls are actions meant to eliminate or reduce hazard through implementation of sound engineering practices.

Ventilation is one of the most common engineering controls used in confined spaces. When ventilation is used to remove atmospheric contaminants from a confined space, the space should be ventilated until the atmosphere is within the acceptable ranges. Ventilation will be maintained during the occupancy if there is a potential for the atmospheric conditions to move out of the acceptable range. Air supply or forced air ventilation will originate from a clean source.

ii. Work Practice (Administrative) ControlsWork practice (administrative) controls are actions meant to eliminate or reduce hazard through changes in work practices (e.g., rotating workers, reducing the amount of worker exposure, and housekeeping).

iii. Personal Protective Equipment (PPE)If the hazard cannot be eliminated or reduced to a safe level through engineering and/or work practice controls, PPE should be used. DESIGNATED INDIVIDUAL will determine the appropriate PPE needed by all personnel entering the confined space, including rescue teams. PPE that meets the specifications of applicable standards will be selected in accordance with the requirements of the job to be performed.

V. ENTRY PERMITS The Confined Space Entry Permit is the most essential tool for assuring safety during entry in confined spaces with known hazards, or with unknown or potentially hazardous atmospheres. The entry permit process guides the supervisor and workers through a systematic evaluation of the space to be entered. The permit should be used to establish safe conditions. Before each entry into a confined space, an

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entry permit will be completed by the Entry Supervisor, who will then communicate the contents of the permit to all employees involved in the operation and post the permit conspicuously near the work location. A standard entry permit will be used for all entries.

A. Key Elements of Entry Permits: i. Space to be entered.

ii. Purpose of entry.iii. Date and authorized duration of the entry permit.iv. Name of authorized entrants within the permit space.v. Means of identifying authorized entrants inside the permit space (i.e., rosters or tracking

systems).vi. Name(s) of personnel serving as Attendant(s) for the permit duration.

vii. Name of individual serving as Entry Supervisor, with a space for the signature or initials of the Entry Supervisor who originally authorized the entry.

viii. Hazards of the permit space to be entered.ix. Measures used to isolate the permit space and to eliminate or control permit space

hazards before entry (i.e., lockout/tagout of equipment and procedures for purging, ventilating, and flushing permit spaces).

x. Acceptable entry conditions.xi. Results of initial and periodic air monitoring tests performed, accompanied by the names

or initials of the testers and the date(s) when the tests were performed.xii. Rescue and emergency services that can be summoned, and the means of contacting

those services (e.g., equipment to use, phone numbers to call).xiii. Communication procedures used by authorized entrants and Attendant(s) to maintain

contact during the entry.xiv. Equipment to be provided for compliance with this Confined Space Program (e.g., PPE,

testing, communications, alarm systems, and rescue).xv. Other information necessary for the circumstances of the confined space that will help

ensure employee safety.xvi. Additional permits, such as for hot work, that have been issued to authorize work on the

permit space.

B. Permit Scope and Duration A permit is only valid for one shift. For a permit to be renewed, the following conditions must be met before each reentry into the confined space:

i. Atmospheric testing will be conducted and the results should be within acceptable limits. If atmospheric test results are not within acceptable limits, precautions to protect entrants against the hazards should be addressed on the permit and should be in place.

ii. Entry Supervisor will verify that all precautions and other measures called for on the permit are still in effect.

iii. Only operations or work originally approved on the permit will be conducted in the confined space.

Whenever there are changing work conditions or work activities that could introduce new hazards to the confined space, either a new permit will be issued or the original permit will be reissued, if possible. The Entry Supervisor will retain each canceled entry permit for at least one (1) year to facilitate the review of the Confined Space Entry Program. Any problems

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encountered during an entry operation will be noted on the respective permit(s) so that appropriate revisions to the confined space permit program can be made.

VI. ENTRY PROCEDURES When entry into a confined space is necessary, the Entry Supervisor may initiate entry procedures including the completion of a confined space entry permit. Entry into a confined space will follow the standard entry procedure outlined below:

A. Prior to Entry The entire confined space entry permit will be completed before a standard entry. Entry will be allowed only when all requirements of the permit are met and it is reviewed and signed by an Entry Supervisor. The following conditions must be met prior to standard entry:

i. Affected personnel must be trained.ii. The internal atmosphere within the confined space must have been tested with a

calibrated, direct-reading instrument by a qualified person.iii. Personnel must be provided with necessary PPE as determined by the Entry Supervisor.iv. Atmospheric monitoring must take place during the entry. If a hazardous atmosphere is

detected:1. personnel within the confined space will be evacuated by the Attendant(s) or

Entry Supervisor until the space can be evaluated to determine how the hazardous atmosphere developed; and

2. controls will be put in place to protect employees before reentry.

B. Opening a Confined Space Any conditions making it unsafe to remove an entrance cover must be eliminated before the cover is removed. When entrance covers are removed, the opening will be promptly guarded by a railing, temporary cover, or other temporary barrier that will prevent anyone from falling through the opening. This barrier or cover will protect each employee working in the space from foreign objects entering the space. If it is in a traffic area, adequate traffic barriers will be erected.

C. Atmospheric Testing Atmospheric test data is required prior to entry into a confined space. Atmospheric testing is required for two distinct purposes: (1) evaluation of the hazards of the permit space, and (2) verification that acceptable conditions exist for entry into that space. If a person must go into the space to obtain the needed data, then Standard Confined Space Entry Procedures will be followed. Before entry into a confined space, a qualified person will conduct testing for hazardous atmospheres. The internal atmosphere will be tested with a calibrated, direct-reading instrument for oxygen, flammable gases and vapors, and potential toxic air contaminants, in that order.

Testing equipment used in specialty areas will be listed or approved for use in such areas. All testing equipment will be approved by a nationally recognized laboratory, such as Underwriters Laboratories or Factory Mutual Systems.

i. Evaluation Testing

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The atmosphere of a confined space should be analyzed using equipment of sufficient sensitivity and specificity. The analysis will identify and evaluate any hazardous atmospheres that may exist or arise so that appropriate permit entry procedures can be developed and acceptable entry conditions stipulated for that space. Evaluation and interpretation of these data and development of the entry procedure should involve a technically qualified professional (i.e., consultant, certified industrial hygienist, registered safety engineer, or certified safety professional).

ii. Verification TestingA confined space that may contain a hazardous atmosphere will be tested for residues of all identified or suspected contaminants. The evaluation testing should be conducted with specified equipment to determine that residual concentrations at the time or testing and entry are within acceptable limits. Results of testing must be recorded by the person performing the tests on the permit. The atmosphere will be periodically retested (frequency to be determined) to verify that atmospheric conditions remain within acceptable entry parameters.

iii. Acceptable LimitsThe atmosphere of the confined spaces will be within acceptable limits when the following conditions are maintained:

1. oxygen: 19.5 percent to 23.5 percent;2. flammability: less than 10 percent of the Lower Flammable Limit (LFL); and3. toxicity: less than recognized American Conference of Governmental Industrial

Hygienists (ACGIH) exposure limits or other published exposure levels [i.e., OSHA Permissible Exposure Limits (PELs) or National Institute of Occupational Safety and Health (NIOSH) Recommended Exposure Limits (RELs)].

D. Isolation and Lockout/Tagout Safeguards All energy sources that are potentially hazardous to confined space entrants will be secured, relieved, disconnected, and/or restrained before personnel are permitted to enter the confined space. Equipment systems or processes will be locked out and/or tagged out as required by COMPANY NAME’s Lockout/Tagout Program prior to permitting entry into the confined space. In confined spaces where complete isolation is not possible, the Entry Supervisor will evaluate the situation and make provisions for as rigorous an isolation as practical. Special precautions will be taken when entering double-walled, jacketed, or internally insulated confined spaces that may discharge hazardous material through the vessel’s internal wall.

Where there is a need to test, position, or activate equipment by temporarily removing the lock or tag or both, a procedure will be developed and implemented to control hazards to the occupants. Any removal of locks, tags, or other protective measures will be done in accordance with COMPANY NAME’s Lockout/Tagout Program.

E. Ingress/Egress Safeguards Means for safe entry and exit will be provided for confined spaces. Each entry and exit points will be evaluated by DESIGNATED INDIVIDUAL to determine the most effective methods and equipment that will enable employees to safely enter and exit the confined space.

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Appropriate retrieval equipment or methods will be used whenever a person enters a confined space. Use of retrieval equipment may be waived by the DESIGNATED INDIVIDUALS if use of the equipment increases the overall risks of entry or does not contribute to the rescue. A mechanical device will be provided to retrieve personnel from vertical confined spaces greater than five (5) feet in depth.

F. Warning Signs and Symbols All confined spaces that could be inadvertently entered will have signs identifying them as confined spaces. Signs will be maintained in a legible condition. The signs will contain a warning that a permit is required before entry. Accesses to all confined spaces will be prominently marked.

VII. EMERGENCY RESPONSE A. Emergency Response Plan

DESIGNATED INDIVIDUAL will maintain a written plan of action that has provisions for conducting a timely rescue of individuals within a confined space, should an emergency arise and this written plan will be kept onsite where the confined space work is being conducted. All affected personnel will be trained on the Emergency Response Plan.

B. Retrieval Systems and Methods of Non-Entry Rescue Retrieval systems will be available and ready when an authorized person enters a permit space, unless such equipment increases the overall risk of entry, or the equipment would not contribute to the rescue of the entrant. Retrieval systems will have a chest or full-body harness and a retrieval line attached at the center of the back near shoulder level or above the head. The retrieval line will be firmly fastened outside the space so that rescue can begin as soon as anyone is aware that retrieval is necessary. A mechanical device will be available to retrieve personnel from vertical confined spaces more than five (5) feet deep.

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Confined Space Entry Permit

Job Site: _______________________ Permit Number: _________

Permit Validity Period: (day/time) ____________________ to _____________

Confined space identification code (if identified) (____________)

Are the Entry Requirements for this Confined Space Available on this jobsite?___

Notes:__________________________________________________________

_______________________________________________________________

_______________________________________________________________

Authorized Personnel

Entry Supervisor:_______________________________________________

Workers Authorized Entry Attendants Fire Watch (hot work)

__________________________ ______________ ____________________

__________________________ ______________ ____________________

__________________________ ______________ ____________________

__________________________ ______________ ____________________

__________________________ ______________ ____________________

__________________________ ______________ ____________________

Hazard Analysis (indicate specific hazards with initials)

_______Oxygen deficiency (less than 19.5%)

_______Oxygen enrichment (more than 23.5%)

_______Flammable gases or vapors (more than 10% of LEL)

_______Airborne combustible dust (meets or exceeds LFL)

_______Toxic gases or vapors (more than PEL)

_______Mechanical hazards

_______Electrical hazards

_______Engulfment hazards

_______Materials harmful to skin

_______Fall Hazards:_____________________________________________

_______Incoming gas lines_________________________________________

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_______Incoming steam lines_______________________________________

_______Other:___________________________________________________

_______Other:___________________________________________________

Employee Training and Pre-Entry Briefing

1. Safe Entry and Rescue Training Conducted on? ________________

2. Mandatory Pre-Entry Briefing Conducted on? ________________

3. Does this job require any special training? Yes____ No ____

If yes, type of training required. _________________________

Contractor Notification

Contractor Notified of: Permit Conditions: Yes____ No ____

Potential Hazards: Yes____ No ____

Communication Requirements: Intrinsically Safe? Yes____ No_____

Visually Inspected? Yes____ No_____

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Lighting Requirements: Intrinsically Safe? Yes____ No_____


_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Special Tools/Equipment: Intrinsically Safe? Yes____ No_____


_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

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Site Preparation

1. Work area isolated with signs and or barriers Yes____ No_____

2. All energy sources locked/tagged out? Yes____ No_____

3. All input lines capped/blinded? Yes____ No_____

4. Is vessel, drained, flushed, neutralized? Yes____ No_____

5. Is vessel, cleaned, purged? Yes____ No_____

6. Ventilation initiated 30 min. before entry? Yes____ No_____

7. Fire extinguishers on hand? Yes____ No_____

8. ______________________________________ Yes____ No_____

9. ______________________________________ Yes____ No_____

10. ______________________________________ Yes____ No_____

Pre-Entry Atmospheric Testing

Action Requirement Reading Time Intervals Levels

1. Test for O2 concentration __ _ %O2 ____ _________ ______

2. Test for flamm concentration _____ <10%LEL ____ _________ ______

3. Test for H2S _____ <10PPM ____ _________ ______

4. Test for Cl2 _____ <.5PPM ____ _________ ______

5. Test for CO _____ <35PPM ____ _________ ______

6. Test for SO2 _____ <2PPM ____ _________ ______

7. Test for toxic concentration _____ PPM ____ _________ ______

____ of ____(TLV=_____)

8. Test for heat stress _____ of ____ _________ ______

9. Test for ____________ _____ ____ _________ ______

10. Test for ___________ _____ ____ _________ ______

Tester: Name:____________________ Signature:____________________

Title:_______________________ Date:___________ Time:___________

Emergency/Rescue Procedures

1. Location of written Emergency/Rescue Plan: _________________

2. Type of Emergency/Rescue Team required and available?

On-site: Yes___ No___ Contact:___________ Phone: __________Page 14 of 16


Off-site: Yes___ No___ Contact:___________ Phone: __________

3. Additional Information:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Safety EquipmentPersonal Protective Equipment Required

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

4. ______________________________________________________________

5. ______________________________________________________________

6. Air purifying respirator? Type:_____________________ Yes____ No_____

7. Self-contained Breathing Apparatus Required? Yes____ No_____

8. Atmospheric Monitor Required? Type:_______________ Yes____ No_____

Area Safety Equipment Required

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

4. ______________________________________________________________

5. ______________________________________________________________

Permit Authorization

I certify that I have inspected the work area for safety and reviewed all safety precautions recorded on this permit.

1. Name:____________________ Signature:_________________________

Title: Confined Space Entry Supervisor Date:___________ Time:___________

2. Name:____________________ Signature:_________________________

Title:_______________________ Date:___________ Time:___________Page 15 of 16


Confined Space Entry Training Log

Company Name: __________________________________________________

Name of Trainer: __________________________________________________

Date of Training: __________________________________________________

Employee Name (printed) Employee Signature

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Documents

€¦ · Web viewPermit-Required Confined Spaces. Responsible Person(s) Assignment of Responsibility. Employer. Program Manager. Entry Supervisor(s) Attendant(s) Entrants / Affected