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CONFINED SPACE ENTRY CHECKLIS1r/PERMIT Paye f of 2 <br /> Project Name: Location: <br /> Date: <br /> Contractor: Job Description: <br /> PERSONNEL' <br /> Entry Supervlsor; (print' pgn) (dw) <br /> Standby Persons; Standby persons are trained in First AMICPR/emergericy procedures (check) <br /> Primary Standby: (prinp (sign) 04%) <br /> Second 6tendby; (prtnp <br /> Won) <br /> EMrams (ell entrants have been trained in the eke hazards and appropriate safety measures (check) <br /> JOB HAZARD EVALUATION: (list the hazards expected to be on site). <br /> Physical Hazards Chemical Hazards <br /> PRECAUTIONS TO BE TAKEN: Yes NIA <br /> Warning/caution signs have been posted and are In place. <br /> All hazardous energy sources are locked out/tagged out, <br /> All piping/process lines to the confined space have baen blinded or disconnected. <br /> Fuel sources (acetylene tanks, gasoline, etc.) have bpwn removed from the confined space. <br /> Mechanical ventilation is used, and has been Inspected for reliability and effectiveness. <br /> All electrical equipment Is grounded, insulated, and GFCI used as appropriate. <br /> Measures have been Implemented to reduce Ignition sources and static charge (including bonding).. <br /> Other (list): <br /> Other (list): <br /> PERSONAL PROTECTIVE EQUIPMENT: <br /> Respiratory protection (type) Boots (type) <br /> Protective clothing (type) Other <br /> Gloves (type) Other <br /> (oomplate other side also) <br /> Envirwunental Health Consultants <br />