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yr= 60 -")D i4.40 rtt vu.l.ttia.r. �,ti. =--- --ti <br /> ENTRE PERMIT tea® <br /> FaR S <br /> PERMIT REQUIRED PACE <br /> 10 <br /> Location: Description of confined area: I permit number: Permit date: <br /> Description of work: Tune issued: Tone expired: <br /> Required it ENTRY CHECKLIST: to be completed by Name of Entry Supervisor 4peinty Name of authorised attendattt(s) <br /> checked Entry Supervisor/Attendant or Entrant <br /> Contined space preparation <br /> (] All lines including veep.to be di%connActea and bkanke0 at close,*tank wheneve p0selbfe.A tanks trdlvai atoned ate backed. <br /> ® <br /> All ninrtnGBl power Swih mes locked all, otherwise.eles7ical wilcne ta;s2d OR. <br /> C' Mechanical ismaticn achieves by disconnecting linkages ar ramowng anve oens or onelns:Ogtenvise.actuipment with mechanical parts,Mucked to pnNert ratution. <br /> ® Onantng wtm ne Wormed from outside of confined space=much as pes.:ble at-ore enterimg. <br /> ❑ Confined space vented mth blowers:an available vrrvttlanem oppraang. <br /> Expected hazards <br /> ❑ Burning,weidiN.bru:n3,or-varic.prodrecng operadorrs piwmed !f yas.',as a hx wOrx permit bW. obtained? ❑ Yes ❑Dkr <br /> Toxic.corrosive.or rummablr materials are present of used In wor{VoceaWe:_ <br /> ❑ TrWo 3tenOSahefe pray develop due to work procedure..de-scrmian from wa11R,avaooratlon of residual cnemradfs,of news of Owtined-.114015 <br /> ❑ Low oxygen concanrraMm may be present of oroduced during entry. <br /> _. Employee Qualifications Name__ .. __ �___..._ of authorized entrants Date SSN <br /> Trained <br /> ❑ Au%.Midayues required to enter must have crmem(annual Confined Space Cad <br /> ❑ Starrdir i employee hab cwrem C.onfned Space Card. <br /> ❑ Numhof of persons limited in absolute minimum. _ <br /> Taney-.mnrnw Otirmce canere hersne can See irll 3Clivity in tank.no job dutdc <br /> btihplered which 0311 room location. <br /> ❑ Standby trainna in hrcr etdn:PR: othetwi-x Meekest or Fire Cepartmerrt alerted of anry. <br /> ❑ nirtarrc t tdrpnones pasted with emergency numbers and marts. <br /> Fire precautions t <br /> ❑ Flfe extingui-:het immediately available (Type A 8 CJ 0 spark resistanttawz pwmdn it n .naMe prewit <br /> ❑ Nix wexx Permit required. Stamm"it n sistutt tads provided B flammable primate <br /> M nitorinq results <br /> Toxicity <br /> Atmospheric testing 01% LFL% ppm or <br /> mafit= <br /> rte' Air monitor otxainad,ane vanled in flood working order. E3eate <br /> entry <br /> ❑ AN munitcm ib within curem calibration. Curing <br /> M Alt meninx whin and <br /> or remuttdv positioned. <br /> ❑ ramproyce instructed to axe agmina space Immediatehr when•rl:um sounds. <br /> Personal protective equipment <br /> 17 (Check Recruiremensy <br /> Haid hal ❑Rcspirno, ❑Hard hat <br /> ® facer.shirts ❑AN-firre resolnitN ❑ Face Shield <br /> ❑ ru0plrb ❑SCSA ❑ Goggia <br /> ❑ Heamtg Proton ❑ ❑meet" Prowelron <br /> ❑ row ❑Other ❑ ter <br /> Rescue and emergency <br /> ❑ Emeitl?ncy SCBA equipment on hared and ready for irnrnadiaM usa by ❑ Aft w wets wear hamr...s ane cam mimny arraohnd M teemse. <br /> standby - (Ung retic ral cquipmrnr weurw tnarra u-overall"It Of entry C. _ <br /> would hot contabute tO the tevaue of the entrant) <br /> ❑ Standby undertmands mathods of emergrivey aunt to aVW HOOM Unit✓S ❑ Pte-entry safety mecdnq nctd•emmvcra bnrtad an tn%cun - <br /> rue Depurtment mucedures, <br /> Authorization Signature re mired before <br /> Signsture of entry WOONSOr Date Time SrQnature of attentrtnt Date TltTle <br /> i • <br /> tiignatyre Or autnorRed?ntient 0a4c � Yima �^. <br />