Laserfiche WebLink
ENTRY PERMIT <br /> FOR PERMIT REQUIRED CONFINED SPACES <br /> Goc;uon I Descnption of confined arca Permit number Permit date <br /> 3 \ 5 �u <br /> Description of work imc issued Time expired <br /> Required if Eney Checklist;to be wmpletad by Enol Name of entry supmtsor(pent) Name of auth0112ed alicrldanits I <br /> checked Supervisor.Anendanr«Frl007 <br /> Confined space preparation <br /> All lines including veru to be disconnceted and blanked off close to Link whenever possible,all ranks valves closed and locked. <br /> All electrical power switches locked ofr,otherwise,electrical twitches tagged off, <br /> Mechanical isolation achieved by discoaneering linkages or removing drive belts or chains;otherwise,equipment%ith mechanical pans blocked to prevent rotation. <br /> Chilling will be performed from outside of confined space as much as possible before entering. <br /> Jr, Confined space vented with blowers;oil available ventilation operating. <br /> Expected hazards <br /> ❑ Burning,welding,hreaing,or spark-producing operations planned. If yes,has a hot work permit been obuined? Cl Yes ❑ No <br /> ❑ Toxic,corrosive,of flammable rnatenals are present or used in work procedure: <br /> Q Toxic atmosphere may develop due to work procedures.de•sorpnon from walls,evaporanon of residual chemicals,of nature of confined spaces. <br /> ❑ Low oxygen concentndan may be present or produced during entry. <br /> Employee QuallGulions Name of Authorized entrants Dare Trained SSN a <br /> All employees required to enter must have current(annual)Confined Space <br /> Moniwr Cord <br /> Standby employee hu cumin Confined Space Monitor Card <br /> Number of persons limited to absolute minimum. <br /> Standby stationed nuLxide where hoshe can see all acriOry in tank;nojob duues <br /> assigned which call from location. <br /> Sundby mined in fent aid/CPR:otherwise Medical or Fire deparuneni alerted of <br /> entry, <br /> Neared Idephones posted with emergency numbers and instructions. <br /> Fire precautions <br /> Fire extinguisher immediately available,(Type A B Cd ❑ Spark re;istaw tools provided if flammable prescnL <br /> ❑ Hot Work Permit required. ❑ Spark resi;uni tools provided if flammable prenenr. <br /> Monitoring results <br /> Toxicity <br /> Atmospheric testing :% LEL% ppm or <br /> m{yma <br /> Air monitor obtained,and verified in good working order Before <br /> entry <br /> Air monitor is within current calibration. envy <br /> b) Air monitor worn and operating continuously on one worker in each entry And <br /> or remotely by standby employee. <br /> Employees instrvcred to exit confined space immediately when alarm sounds. <br /> Personal protective equipment <br /> Icheck nquimnents) <br /> hard Par ❑ Respirator ❑ Hard hat <br /> Face shield ❑. Air-line respirator ❑ Face shield <br /> GoBgles 5CBA ❑ Goggles <br /> ❑ Hearing protection ❑ ❑ Hearing protection <br /> ❑ Other: ❑ Other ❑ Other <br /> Rcscue and cmcrgenn <br /> ❑ Emergency SOBA equipment on hand and ready for immediate use by All enlnnu wear harness and continually:ruched to lifeline. (Unless rvviewl <br /> Sundby equipment would increase overall risk of entry or would not coninhute to the <br /> fe3CYe of the CnlranL) <br /> Standby Depart nL methods ofemergency ales to others Health Unit pre-entry safery meeting held:employees briefed on rescue procedures. <br /> and Fire Department- <br /> Authorization Signature (required before entry) <br /> Signature of entry supervisor Date Time Signature of miendsm Date Time <br /> I <br /> Signature of authorued entrant Dale Time <br /> This permit is to be posted at the curry site <br /> PUI:iRSuiay%CSII&PRCS Dou�PRCS Corp.duc <br />