COMPLIANCE INFO_2008 - 2011 - Laserfiche WebLink

Home Browse Search

i i SAFE WORK PRACTICES FOR CCNTRACTORS WORKING AT RETAIL PE rROLEUM/CONVENIENCE FACILITIES 59 _ � I r PERMIT TO WORK For PetroleumlConvenlence Sites Continued f i Has the Lilt Plan been completed by a competent person? YE NO i Roes the equipment have the size,load,and svring YES �lQ ❑. ❑ capacity to do the lob safely? 0 d Air or hydraulic systems inspected for deterioration or leakage ❑ ❑ Tool Box discuss!on conducted&lift plan communicated 11 ❑ I I in lines,tanks,valves,drain m ,etc? to all affected ersonnel? Hooks,hoist chains,and end connections checked for signs ofL3 ❑ Are outriggers set before hoisting operations WA wear,IvAst cracks,distorted links or excessive stretch begin? ❑ ❑ ❑ Has rigging been performed by a competentperson? O Cl Is Eger cribbing bein g used ❑ 13 p Is the hoisting equipment silting on a stable surface? ❑ ❑ Overhead risks evaluated as part of the lift Ian? ❑ ❑ ❑ Is work are aprope barn eadedisolated? ❑ ❑ Is the operator certified for the equipment? ❑ ❑ Has tie hoisting equipment been Inspected before use? ❑ ❑ Are period'c inspections complete and documented? I] ❑ s e i Atmospheric Tests(Pre- Time; 02 %LEL Taxidly Isolation&Ventilation _ i(19.5%-23.5%): (<10%): H2S,Benzene): l Source Isolation Electdcai LOTO ❑YES ❑NO ❑NA (No Entry) Pumps off&LOTO ❑YES ❑NO ❑NA j Lines Disconnected _ ❑YES ❑NO ❑NA Valves shut and LOTO ❑YES ❑NO ❑NA _ l Note:If an 'NO"Is checked above fill out"Permit Required Confined Space En&j Permit"section, If all"YES"or`IVA"Continue on. _,w Atmosphere Mechan(cal Forced Air y O YES ❑NO ❑NA ventilation: Naftral Vent lotion Onix _ C YES _ ❑NO 0 N L f Atmospheric Tests(Post-Isolation Tima: 02 %LEL. Toxicity j &Ventilation) 1-123,Benzene: Pre. surroundinq Area Free of Hazards? ❑YES _ E3 NO ❑NA Entry Proper noflfrca9ons made? _ _ ❑YES T ❑NO ❑NA CheckDoes your knowledge indicate the area will remain free of all ❑YES Q NO ❑NA I j List atmospheric hazards? _ Are you trained in confined space onW. ❑YES 13 NO_ _ ❑NA Are You trained in the operation of the air monitor used? ❑YES ❑NO ❑NA Has the monitor been calibrated before use? _ CI YES ❑NO ❑NA i Did you test the atmosphere in the space before enn? ❑YES _ E3 NO ❑NA Did the atmosphere check as acceptable? -__ _ ❑YES Q NO 13 NA Will the atmosphere be continuous) monitored? ❑YES Q NO D NA NOTE:IF ANY OF THE ABOVE ANSINERS ARE"NO"DO NOT ENTER iTelP.'v.3:!Y�!(:-Nj!��M,.JTi!:'tl!tii37i��:'I"=.�•;y3 i.�5,. _ .-ti. _ _ _ __ ____...��__ •_.,':In_to._.. 'ik:"�:}.H31. ai:CS?:tl:••u��..k:ii"tcc3!!!rh-..:• . - rr:eek.,:�•r.?.,v:r�:-•!a:+•_:��r,:?Fi,�e•.'�.�.t$a!�F.°CI�IFRNE4_&�AGE�titl'BRl�'P.ERNII�. t':&4&!�µ-ectZoina"t' i�L .:__, -� �-r��'�ncm.,;may Pu of En' En Supervisor. Attendants: 1. 2. Entrants: 1. 2. 3. 4. _ 3. 4. If i Pre-Entry Checks: ❑LO TO _ _` Cl Eawgiancy Rescue Plan ❑Secure Area ❑Ventilation _ ❑PPE Q Upas ledetedJMocked_ ❑Re balers ❑Fire E)dlrAuisher _ t ❑Purr_ _- _ 13HotWork Penmt ❑Communication systom ❑Lighting ❑PPE ❑Lines Isolated/blocked 10 Respirators ❑Fire Extinguisher j i Minimum Requirements To Be Completed&Reviewed Before Entry _� Continuous Test P51. Initials Time: Time: Time: Time: Time atmosphere Oxygen 19.59vr23.5% Value: Varve: Value: Muir Value: Monitoring: LEL 10% Velua Valu.. VWUe: _ Valle: VaII (Record at least HzS <10 PAM varus: value: Velue: Velua. _ Vahm i every 30 minutes) --- Other Value: Valle: Value: Valla Value: Remarks: Gas Tester MakeiModel: Instrument Serial Number:- Have umberrHave all of the conditions above been satisfied? !YES❑ _ NO❑ Attendant si nature: lEntry Supervisor Sinature: ! I ensure this permit has been filled out completely and in conjunction with all applicable OSHA requirements to provide a safe workplace for all i workers and myself. I will take action to eliminate hazardous conditions or acts Identified on this job site. Person In Charge Signature: I