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Pre Entry Personal Safety Checklist: <br /> Ventilation Maintained <br /> Respiratory Equipment <br /> Clothing <br /> Head,Hand,and Foot Protection <br /> Life Lines and Harness <br /> Explosion Proof Lighting <br /> Correct Polarity Checked for explosion proof equipment <br /> Standby Person Present <br /> Emergency Rescue Respiratory Equipment present <br /> Fire Extinguishers Present <br /> Remarks: <br /> Atmospheric Gas Tests Performed: <br /> Oxygen Reading LFL Reading Location Time <br /> Remarks: <br /> Signature <br /> Type of Entry Class <br /> Circle one:Class A Class B Class C <br /> Note:Please see page 3 of this form for definitions of types of entry class <br /> I,the undersigned,hereby authorize work in the confined space until the time specified below: <br /> Signature of Qualified Person <br /> Time and date permit issued: <br /> (Time)Date Page 2 <br /> of 3 <br /> 37 <br />