Permit-Required Confined Space Program

(To customize, please edit the highlighted areas of the program)

Created By: Approved By:Creation Date: Revision Date:

Disclaimer: The Georgia Tech Safety and Health Consultation Program has created this document to assist companies in establishing their own Permit-Required Confined Space Program. However, in order for the employer to achieve OSHA compliance with this document, the employer must develop site-specific entry procedures in accordance with 29 CFR 1926, Subpart AA.

Note: This program template was written from the perspective of the entry employer in accordance with 1926, Subpart AA. Therefore (Company Name) will reference the entry employer throughout this document.

1. Company Policy

Company Name is committed to providing a safe and healthful work environment for our entire staff. The purpose of this program is to ensure that proper protection is taken for employees that work in confined spaces. This Permit-Required Confined Space (PRCS) Program has been developed in accordance with Occupational Safety and Health Administration (OSHA) regulation 29 CFR 1926, Subpart AA.

All personnel are expected to strictly adhere to the program to prevent serious injuries and illnesses. Failure to follow this procedure may result in disciplinary action.

2. Definitions

Refer to the glossary in Appendix A for further information on definitions.

Note: Confined space means a space that:

1. Is large enough and so configured that an employee can bodily enter and perform assigned work; and

2. Has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins, hoppers, vaults, and pits are spaces that may have limited means of entry); and

3. Is not designed for continuous occupancy.

Permit-Required Confined Space means a confined space that has one or more of the following characteristics:

1. Contains or has the potential to contain a hazardous atmosphere;

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2. Contains a material that has the potential for engulfing an entrant;3. Has an internal configuration such that an entrant could be trapped or asphyxiated by

inwardly converging walls or by a floor that slopes downward and tapers to a smaller cross-section; or

4. Contains any other recognized serious safety or health hazard (e.g., a mechanical hazard).

3. Entry Employer Responsibilities

Company Name will:

Coordinate entry operations with the controlling contractor (or host employer in the absence of a controlling contractor) of the jobsite

Designate the persons who are to have active roles in entry operations in Appendix B; Identify the duties of each affected employee in accordance with the Training Section of

this program (see Section 13); Train each affected employee in accordance with Training Section of this program (see

Section 13); Consult with affected employees and/or their authorized representatives on the

development and implementation of all aspects of this program; and Make all the information required to be developed in accordance with

29 CFR 1926, Subpart AA available for all affected employees and/or their authorized representatives.

4. Site Specific Entry Procedures

Company Name will develop site-specific entry procedures for each confined space that is permitted for entry. [Once developed, site-specific entry procedures should be added to Appendix C of this template.]

Company Name will develop and implement the means, procedures, and practices necessary for safe entry, including the following activities:

Identifying and evaluating permit space hazards; Controlling hazards and specifying acceptable entry conditions; Isolating the permit space and physical hazard(s) within the space; Purging, inerting, flushing, or ventilating the permit space as necessary to eliminate or

control atmospheric hazards; Providing barriers to confined spaces that protect entrants from hazards created by

pedestrians, vehicles, or other external factors; Verifying conditions within the permit space are acceptable throughout the duration of the

authorized entry; Determining that, in the event the ventilation system stops working, the monitoring

procedures will detect an increase in atmospheric hazard levels in sufficient time for the entrants to safely exit the permit space;  

Developing and executing procedures to enable an attendant to respond to an emergency affecting one or more of the permit spaces being monitored without distraction from the

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attendant’s responsibilities, if a single attendant will be monitoring multiple permit spaces simultaneously;

Verifying conditions in the permit space are acceptable for entry throughout the duration of an authorized entry, and ensuring that employees are not allowed to enter into, or remain in, a permit space with a hazardous atmosphere unless the employer can demonstrate that personal protective equipment (PPE) will provide effective protection for each employee in the permit space and provides the appropriate PPE to each employee;

Eliminating any conditions (for example, high pressure) that could make it unsafe to remove an entrance cover;

Developing and executing procedures for summoning rescue and emergency services, for rescuing entrants from permit spaces, for providing necessary emergency services to rescued employees, and for preventing unauthorized personnel from attempting a rescue;

Developing and employing procedures to coordinate entry operations when employees of more than one employer are working simultaneously as authorized entrants in a permit space, so that employees of one employer do not endanger the employees of any other employer;

Providing an early-warning system that continuously monitors for non-isolated engulfment hazards. The system must alert authorized entrants and attendants in sufficient time for the authorized entrants to safely exit the space;

Performing continuous monitoring of atmospheric hazards unless it can be demonstrated that the equipment for continuously monitoring a hazard is not commercially available or that periodic monitoring is of sufficient frequency to ensure that the atmospheric hazard is being controlled at safe levels. If continuous monitoring is not used, periodic monitoring is required with sufficient frequency to ensure that acceptable entry conditions are being maintained during the course of entry operations;

Verifying that after authorized entry has concluded, or entry operations have been completed, the permits shall be cancelled and the permit space isolated from unauthorized entry; and

Ensuring a safe method of entering and exiting the space. (If a hoisting system is used, it must be designed and manufactured for personnel hoisting; however, a job-made hoisting system is permissible if it is approved for personnel hoisting by a registered professional engineer, in writing, prior to use.)

Before entry operations begin, Company Name will:

Obtain all of the controlling contractor’s information regarding permit space hazards and entry operations; and

Inform the controlling contractor of the permit space program that the entry employer will follow, including any hazards likely to be confronted or created in each permit space.

Company Name will coordinate entry operations with the controlling contractor when: More than one entity performs permit space entry at the same time; or Permit space entry is performed at the same time that any activities that could foreseeably

result in a hazard in the permit space are performed.

After entry operations, Company Name will inform the controlling contractor in a timely manner of the permit space program followed and of any hazards confronted or created in the permit space(s) during entry operations.

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5. Confined Space Evaluation

Company Name’s competent person will evaluate the workplace to determine if any spaces are permit-required confined spaces, using the Confined Space Evaluation Work Sheet in Appendix D. (Refer to the Permit-Required Confined Space Flow Chart in Appendix E for additional assistance with evaluating confined spaces).

If the workplace contains permit spaces, Company Name’s competent person will inform exposed employees by posting danger signs or by any other equally effective means, of the existence and location of and the danger posed by the permit spaces.

o Danger signs should read as follows: DANGER—PERMIT-REQUIRED CONFINED SPACE, DO NOT ENTER

o Inform in a timely manner and in a manner other than posting, its employees’ authorized representatives and the controlling contractor of the existence and location of, and the danger posed by, each permit space.

If employees are not permitted to enter a confined space, Company Name will take effective measures to prevent employees from entering the space.

If employees are permitted to enter confined spaces, Company Name will permit such entry only in accordance with this confined space program.

A list of all confined spaces at Company Name’s facility is located in Appendix F.

If Company Name receives notice of the location of a permit-space(s) from another employer that employees are not authorized to enter, Company Name will take effective measures to prevent those employees from entering that permit-space(s).

6. Testing and Monitoring

Company Name will continuously monitor atmospheric hazard(s) unless it can be demonstrated that the equipment used for continuous monitoring is not commercially available or that periodic monitoring is of sufficient frequency to ensure that the atmospheric hazard(s) are being controlled at safe levels. If continuous monitoring is not used, periodic monitoring will be performed at sufficient frequencies to ensure that acceptable entry conditions are being maintained during the course of entry operations;

When testing atmospheric hazards, Company Name will test at varying depths of the space in the following sequential order: oxygen, r combustible gases vapors, and r toxic gases or vapors. Each authorized entrant and/or that employee’s authorized representative will be given an opportunity to observe the results from the pre-entry testing and any subsequent testing or monitoring of the permit space.

In the event that the authorized entrant and/or that employee’s representative has suspicion that the testing/monitoring performed was not adequate and requests that the space be reevaluated for atmospheric hazards, Company Name will immediately reevaluate the space in the presence of that authorized entrant and/or that employee’s authorized representative.

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Company Name will provide the results of all testing conducted for the permit space to all authorized entrants and/or their authorized representatives immediately.

7. Entry Permit

Prior to authorizing entry, the Entry Supervisor will document the completion of the established entry procedures by completing the permit-required confined space entry permit located in Appendix G. Prior to employee entry, the Entry Supervisor identified on the permit will sign the permit to authorize entry. The Entry Supervisor will provide the completed permit for review at the time of entry to all authorized entrants or their authorized representatives, by posting it at the entry portal or by any other equally effective means, so that the entrants can confirm that pre-entry preparations have been completed.

8. Termination, Suspension, and Cancellation of Entry Permit

The Entry Supervisor will terminate and cancel the entry permit when:

Entry operations covered by the permit have been completed; A condition that is not allowed under the entry permit arises in or near the permit space;

or Suspend or cancel the entry permit and fully reassess the space before allowing reentry

when a condition that is not allowed under the entry permit arises in or near the permit space and that condition is temporary in nature and does not change the configuration of the space or create any new hazards within it.

9. Equipment

Company Name will provide the following equipment at no cost to employees, maintain the equipment properly, and ensure employees use the equipment properly:

Testing and monitoring equipment; Ventilating equipment needed to obtain acceptable entry conditions; Communications equipment; Personal protective equipment; Lighting equipment that that is approved for the ignitable or combustible properties of the

specific gas, vapor, dust, or fiber that will be present, and that is sufficient to enable employees to see well enough to work safely and to exit the space quickly in an emergency;

Barriers and shields; Equipment such as ladders, needed for safe egress and ingress by authorized entrants; Rescue and emergency equipment, except to the extent that equipment is provided by

rescue services; and Any other equipment necessary for safe entry into and rescue from permit spaces.

A list of the specific equipment required to safely conduct entry operations in each permit space will be documented in each permit space’s specific entry procedures.

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10. Evacuation

Company Name requires that authorized entrants evacuate permit spaces immediately when: Given an order by the entry supervisor or attendant to evacuate; Attendant detects a prohibited condition; Attendant detects the behavioral effects of hazard exposure in an authorized entrant; Attendant detects a situation outside the space that endanger the authorized entrants; Attendant cannot effectively and safely perform all of the duties listed; Entrant recognizes any warning sign or symptom of exposure to a dangerous condition; Entrant detects a prohibited condition; Evacuation alarm is activated; or Entry supervisor terminates, suspends, and/or cancels entry permits.

11. Unauthorized Entry

Company Name will not permit the entry into permit spaces by unauthorized entrants. In the event that an unauthorized person(s) approaches or enters a permit space the actions below will be taken by the attendant(s) and entry supervisor.

The attendant(s) will: Warn unauthorized persons that they must stay away from the permit space; Advise unauthorized persons that they must exit immediately if they have entered the

permit space; and Inform the authorized entrants and the entry supervisor if unauthorized persons have

entered the permit space.

The entry supervisor will remove the unauthorized person(s) from the area and/or space.

If it is concluded that posting and training are inadequate to prevent unauthorized entry into permit spaces, covers, guardrails, fences, locks or other methods of restricting access shall be implemented.

12. Program Review

A. Canceled Entry Permits

Company Name will retain each canceled entry permit for at least 1 year to facilitate the review of the permit-required confined space program. Any problems encountered during an entry operation will be noted on the pertinent permit so that appropriate revisions to the space can be made.

B. Entry Operations

Company Name will review entry operations if there is reason to believe that the measures taken under the permit-required confined space program may not protect employees and revise the program to correct deficiencies found to exist before subsequent entries are authorized.

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13. Training

Company Name will provide training at no cost to the employee so that all affected personnel acquire the understanding, knowledge, and necessary skills for the safe performance of duties specified by this program. Training will be provided:

In both a language and vocabulary that the employee can understand; Before the employees are first assigned duties under this program; Before there is a change in assigned duties; Whenever there is a change in permit space operations that presents a hazard which an

employee has not been previously trained; Whenever the employer has reason to believe there is deviation from the permit space

entry procedures specified in this program or there are inadequacies in the employee’s knowledge or use of these procedures.

Company Name will maintain affected employee training records by completing the Training Certification Log in Appendix H.

A. Authorized Entrants

Company Name will ensure that all authorized entrants: Know the hazards that may be faced during entry, including information on the mode,

signs, or symptoms, and consequences of exposure; Properly use equipment specified by the entry procedure for the space; Communicate with the attendant as necessary to enable the attendant to monitor entrant

status and alert entrants of the need to evacuate the space; Alert the attendant whenever:

o The entrant recognizes any warning sign or symptom of exposure to a dangerous situation; or

o The entrant detects a prohibited condition. Exit from the permit space in accordance with section 10 of this program.

B. Attendants

Company Name will provide at least one attendant outside of permit spaces, which entry has been authorized for the duration of entry operations.

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All authorized attendants will: Know the hazards that may be faced during entry, including information on the mode,

signs, or symptoms, and consequences of exposure; Be aware of possible behavioral effects of hazard exposure in authorized entrants; Continuously maintain an accurate count of authorized entrants in the permit space using

the Authorized Entrant Log in Appendix and ensure that the means used to identify authorized entrants accurately identifies who is in the permit space;

Remain outside of the permit space during entry operations until relieved by another attendant;

Communicate with authorized entrants as necessary to monitor entrant status and to alert entrants of the need to evacuate the space;

Monitor activities inside and outside the space to determine if it is safe for entrants to remain in the space and order authorized entrants to evacuate the permit space immediately in accordance with section 10 of this program;

Summon rescue and other emergency services as soon as the attendant determines the authorized entrants may need assistance to escape from permit space hazards;

Take the actions specified in section 11 of this program when unauthorized person(s) approach or enter a permit space while entry is underway;

Perform non-entry rescues in accordance with the company’s rescue procedure; and Perform no duties that might interfere with the attendant’s primary duty to monitor and

protect the authorized entrants.

C. Entry Supervisors

Company Name will ensure that each entry supervisor:

Knows the hazards that may be faced during entry, including information on the mode, signs, or symptoms, and consequences of exposure;

Verifies by checking that the appropriate entries have been made on the permit, that all tests specified by the permit have been conducted, and that all procedures and equipment specified by the permit are in place before endorsing the permit and allowing entry to begin, in accordance with section 7 of this program;

Terminates the entry and cancels or suspends the permit in accordance with section 8 of this program;

Verifies that rescue services are available and the means for summoning them are operable, and that the employer will be notified as soon as the services become unavailable;

Removes unauthorized individuals in accordance with section 11 of this program; and Determines whenever responsibility for a permit space entry operation is transferred and at

intervals dictated by the hazards and operations performed within the space, that entry operations remain consistent with terms of the entry permit and that acceptable entry conditions are maintained.

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14. Rescue and Emergency Services

A. (If Designating Outside Service)

The Company Name will designate an entry rescue service whenever non-entry rescue is not selected.

Prior to designating a rescue and emergency service, Company Name will:

Evaluate the prospective rescuer’s ability to respond to a summoned rescue in a timely manner, considering the hazards identified;

Evaluate the prospective rescue service’s ability, in terms of proficiency with rescue related tasks and equipment, to function appropriately while rescuing entrants from the particular permit space or types of permit spaces identified;

Select the rescue team or service from those evaluated that:o Has the capability to reach the victim(s) within a time frame that is appropriate for

the permit space hazards identified; ando Is equipped for and proficient in performing the needed rescue services

Inform each rescue team or service of the hazards they may confront while called to perform rescue at the site; and

Provide the rescue team or service selected with access to all permit spaces from which rescue may be necessary so that the rescue service can develop appropriate rescue plans and practice rescue operations.

B. (If Designating In-House Rescue Team)

Company Name will provide their in-house rescue team with the following:

Personal protective equipment needed to conduct permit space rescues; Training to perform assigned rescue duties; and Training in basic first-aid and cardiopulmonary resuscitation (CPR) and use of the

AED (if available).

The rescue team will practice making permit space rescues at least once every 12 months, by means of simulated rescue operations in which they remove dummies, manikins, or actual persons from the actual permit spaces or from representative permit spaces.

C. Non-entry Rescue:

Whenever feasible, Company Name’s rescue plan will specify methods that do not involve entry by rescuers into the confined space. Whenever non-entry rescue is selected, the Company Name will ensure that retrieval systems or methods are used whenever an authorized entrant enters a permit space, and must confirm, prior to entry, that emergency assistance would be available in the event that non-entry rescue fails.  o facilitate non-entry rescue, Company Nam e will provide

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and strictly enforce the utilization of retrieval systems by all authorized entrants in accordance with the following configuration, during every entry:

A chest or full body harness attached to a retrieval line at the center of the entrant’s back near shoulder level, with the other end of the retrieval line attached to a mechanical device or a fixed point outside the permit space.

Note: Wristlets will be used in lieu of a chest or full body harness if it is determined by Company Name that the use of either harness is infeasible or creates a greater hazard and determines that the use of wristlets is the safest and most effective alternative.

If an injured entrant is exposed to a substance(s), Safety Data Sheets or any other similar written information will be made available to the medical facility treating the exposed entrant immediately.

15. Entry Through Reclassification

There may be some situations where Company Name’s competent person may be able to temporarily reclassify permit-required confined spaces as non-permit spaces. Permit spaces may only be temporarily reclassified as non-permit spaces if the conditions specified in Appendix I are met.

16. Entry Through Alternate Procedures

There may be some situations where Company Name may be able to authorize entry into permit spaces through alternate procedures. Permit spaces may only be entered through alternate procedures if the conditions specified in Appendix K are met.

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Appendix A.

Glossary

Attendant: an individual stationed outside one or more permit spaces who monitors the authorized entrants and who performs all attendant's duties assigned in the employer's permit space program.

Authorized Entrant: an employee who is authorized by the employer to enter a permit space.

Competent Person: one who is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has the authorization to take prompt corrective measures to eliminate them.

Confined Space: a space that:

1) Is large enough and so configured that an employee can bodily enter and perform assigned work; and

2) Has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins, hoppers, vaults, and pits are spaces that may have limited means of entry.); and,

3) Is not designed for continuous employee occupancy.

Controlling Contractor: is the employer that has overall responsibility for construction at the worksite.

Note to the definition of "Controlling Contractor." If the controlling contractor owns or manages the property, then it is both a controlling employer and a host employer.

Engulfment: the surrounding and effective capture of a person by a liquid or finely divided (flowable) solid substance that can be aspirated to cause death by filling or plugging the respiratory system or that can exert enough force on the body to cause death by strangulation, constriction, or crushing.

Entry: the action by which a person passes through an opening into a permit-required confined space. Entry includes ensuing work activities in that space and is considered to have occurred as soon as any part of the entrant's body breaks the plane of an opening into the space.

Entry Employer: any employer who decides that an employee it directs will enter a permit space.

Note to the definition of "Entry Employer." An employer cannot avoid the duties of the standard merely by refusing to decide whether its employees will enter a permit space, and OSHA will consider the failure to so decide to be an implicit decision to allow employees to enter those spaces if they are working in the proximity of the space.

Entry Permit (Permit): the written or printed document that is provided by the employer to allow and control entry into a permit space and that contains the information specified in paragraph (f) of this section.

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Entry Supervisor: the person (such as the employer, foreman, or crew chief) responsible for determining if acceptable entry conditions are present at a permit space where entry is planned, for authorizing entry and overseeing entry operations, and for terminating entry as required by this section.

Hazardous Atmosphere: an atmosphere that may expose employees to the risk of death, incapacitation, impairment of ability to self-rescue (that is, escape unaided from a permit space), injury, or acute illness from one or more of the following causes:

1) Flammable gas, vapor, or mist in excess of 10 percent of its lower flammable limit (LFL);

2) Airborne combustible dust at a concentration that meets or exceeds its LFL;3) Atmospheric oxygen concentration below 19.5 percent or above 23.5 percent;4) Atmospheric concentration of any substance for which a dose or a permissible

exposure limit is published in Subpart G, Occupational Health and Environmental Control, or in Subpart Z, Toxic and Hazardous Substances, of this Part and could result in employee exposure in excess of its dose or permissible exposure limit;

5) Any other atmospheric condition that is immediately dangerous to life or health.

Host Employer: the employer that owns or manages the property where the construction work is taking place.

Note to the definition of "Host employer." If the owner of the property on which the construction activity occurs has contracted with an entity for the general management of that property, and has transferred to that entity the information specified in § 1926.1203(h)(1), OSHA will treat the contracted management entity as the host employer for as long as that entity manages the property. Otherwise, OSHA will treat the owner of the property as the host employer. In no case will there be more than one host employer.

Immediately Dangerous to Life or Health (IDLH): any condition that poses an immediate or delayed threat to life or that would cause irreversible adverse health effects or that would interfere with an individual's ability to escape unaided from a permit space.

Non-Permit Confined Space: a confined space that does not contain or, with respect to atmospheric hazards, have the potential to contain any hazard capable of causing death or serious physical harm.

Oxygen Deficient Atmosphere: an atmosphere containing less than 19.5 percent oxygen by volume.

Oxygen Enriched Atmosphere: an atmosphere containing more than 23.5 percent oxygen by volume.

Permit-Required Confined Space (Permit Space): a confined space that has one or more of the following characteristics:

1) Contains or has a potential to contain a hazardous atmosphere;2) Contains a material that has the potential for engulfing an entrant;3) Has an internal configuration such that an entrant could be trapped or asphyxiated by

inwardly converging walls or by a floor which slopes downward and tapers to a smaller cross-section; or

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4) Contains any other recognized serious safety or health hazard.

Permit-Required Confined Space Program (Permit Space Program): the employer's overall program for controlling, and, where appropriate, for protecting employees from, permit space hazards and for regulating employee entry into permit spaces.

Retrieval System: the equipment (including a retrieval line, chest or full-body harness, wristlets, if appropriate, and a lifting device or anchor) used for non-entry rescue of persons from permit spaces.

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Appendix B.

List of Affected Personnel(Program Supervisor, Authorized Entrants, Attendants, and Entry Supervisors)

Program Supervisor

Entrants1.2.3.4.5.6.7.8.9.10.

Attendants1.2.3.4.5.6.7.8.9.10.

Entry Supervisors1.2.3.4.5.6.7.8.9.10.

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Appendix C.

Site-Specific Entry ProceduresOnce developed, your site specific procedures should be inserted here.

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Appendix D.

Confined Space Evaluation Work Sheet 1

Evaluator: Zone: Date: Description: Building:

Confined Space: A volume that has ALL of the following characteristics:□ The space is large enough and so configured so that a worker can bodily enter and perform work.□ The space has a limited or restricted means of entry and/or exit.□ The space is not designed for continuous human occupancy.

Permit-Required Confined Space: A space that contains, or has the potential to contain, one or more of the following:

□ The space has a hazardous atmosphere.□ The space has a material that could engulf an entrant.□ The space has an internal configuration that might cause an entrant to be trapped or asphyxiated

by inwardly converging walls, or by a floor sloping downward and tapering to a smaller cross section.

□ The space has any other recognized serious safety or health hazard such as:□ Exposed/Unprotected equipment □ Exposed/Unprotected High/Low temperatures□ Exposed/Unprotected

electrical conductors□ Exposed/Unprotected fall hazards

□ ACM (Asbestos-Containing Material) □ Other:

Alternate Entry Space:A Confined Space that only has both of the following conditions:

□ The only hazard in the space is an actual or potential hazardous atmosphere□ Forced air ventilation alone is sufficient to maintain the permit space safe for entry

Hazards (Actual or Potential) During Normal Operating Conditions:□ Atmospheric □ Physical □ Electrical□ Configuration □ Heat/Steam □ Engulfment/Drowning

Space Classification during NORMAL operating conditions:

□ Non-Permit Required Confined Space □ Permit Confined Space □ Alternate Entry Space

Occupants/Use:

Departments/Personnel routinely accessing space:

1 This information is based on Yale’s Environmental Health & Safety’s “Confined Space Evaluation Work Sheet,” https://ehs.yale.edu/sites/default/files/files/confined-space-evaluation.pdf.16

Purpose for accessing space:

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Notes:

Photographs

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Appendix E.

Permit-Required Confined Space Decision Flow Chart

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Appendix F.

Confined Space Inventory List (Permit-Required, Reclassified, and Non-Permit-Required)

Permit Required Confined Space(s)Number Classification Description Location

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Appendix G.

Permit-Required Confined Space Entry Permit

CONFINED SPACE ENTRY PERMIT 2

Confined Space Location/Description/ID Number Date:

Purpose of Entry

Time In: Time Out:

Permit Canceled Time: Reason Permit Canceled:

Supervisor:

Rescue and Emergency Services:

Early warning system:

Communication Procedures:

DO NOT ENTER IF PERMISSIBLE ENTRY LEVELS ARE EXCEEDED

Test Start and Stop Time:Start Stop

Permissible Entry Level% of Oxygen 19.5% to 23.5%% of LEL Less than 10%Carbon Monoxide 35 PPM (8 hr.)Hydrogen Sulfide 10 PPM (8 hr.)OtherName(s) or Person(s) testing:

Test Instrument(s) used—Include Name, Model, Serial Number and Date Last Calibrated:2 This document created by the University of Wisconsin at River Falls as part of Susan Harwood Grant # SH-22318-11.

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Hazards of Confined Space

Yes No Special Requirements Yes No

Oxygen deficiency Hot Work Permit RequiredCombustible gas/vapor Lockout/TagoutCombustible dust Lines broken, capped, or blankedCarbon Monoxide Purge-flush and ventHydrogen Sulfide Secure Area–Post and FlagToxic gas/vapor VentilationToxic fumes Other—List:Skin- chemical hazards Special EquipmentElectrical hazard Breathing apparatus- respiratorMechanical hazard Escape harness requiredEngulfment hazard Tripod emergency escape unitEntrapment hazard LifelinesThermal hazard Lighting (explosive proof/low voltage)Slip or fall hazard PPE: goggles, gloves, clothing, etc.

Fire Extinguisher

CFM-Ventilation Size-Cubic Feet Pre-Entry Time Entry Supervisor Notified Before Entrance

Time Notified:

Entry Supervisor Notified After Entrance

Time Notified:

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Authorized Entrants Authorized Attendants

PERMIT AUTHORIZATIONI Certify that all actions and conditions necessary for safe entry have been performed.

Name (Print):

Signature:

Date: Time/Authorized Duration of Permit:

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Appendix H.

Permit Required Confined Space Training Roster

Note: The “responsibility” column below should identify the level of training received based on each affected employee’s title (entry supervisor, entrant, attendant).

Training Performed By:

Employee Name Responsibility Employee Signature Training Date

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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Appendix I

Reclassification of Permit Required Confined Spaces

A PRCS can be reclassified as a non-permit-required confined space under the following conditions:

The space poses no actual or potential atmospheric hazards and if all the hazards are eliminated without entry into the space

If it is necessary to enter the PRCS to eliminate hazards, such entry will be performed under a permit space program. If testing and inspection during that entry shows that the hazards in the space have been eliminated, the permit space may be reclassified as a non-permit confined space for as long as the hazards remain eliminated.

If hazards arise within a permit space that has been reclassified to a non-permit space, the workers space shall exit the space. A reevaluation is necessary to determine whether it must be reclassified as a permit space.

When a permit required confined space is to be reclassified to a “non-permit” status, Company Name’s competent person will issue a written certification that contains the date, the location of the space and the signature of Company Name’s competent person making the determination that all hazards have been eliminated. The certification shall be made available to each employee entering the space or to that employee's authorized representative. 

This documentation must be completed each time a permit-required confined space is reclassified and remains in effect only as long as all of the hazards remain eliminated. This reclassification form is located in Appendix H.

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Appendix J.

Permit-Required Confined Space Reclassification Form3

Section 1: PRCS IdentificationApplication Date: Confined Space ID No. and Name :

Project: Description of Work:

Company: Start Work Date:

Location/Area: Equipment to be Engaged:

Section 2: Hazard IdentificationList all known and potential hazards associated with the space and introduced by planned work:

Describe how each hazard will be eliminated:

Section 3: PRCS Reclassification ApprovalI confirm that the named PRCS and the planned work qualify for temporary Reclassification.

Performing Authority (Name): Signature: Date: Time:

Issuing Authority (Name): Signature: Date: Time:

3 This information is based on SMU’s “Confined Space Temporary Declassification” form, https://www.smu.edu/-/media/Site/BusinessFinance/RiskMgmt/Health-Safety/Confined-Space-S-004/EHS-SF-004-7-CSE-Temp-Declassify--V1.pdf?la=en.

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Appendix K

Alternate Procedures

Company Name may use alternate procedures for entering a permit space under the conditions listed below. Employees entering a permit space under alternate procedures need not comply with the following parts of this program:

Permit Required Confined Space Program; Permit System; Entry Permit; Duties of Authorized Entrants; Duties of Attendants; Duties of Supervisors; and Rescue and Emergency Services, provided that,

o The only hazard is an actual or a potentially hazardous atmosphere;o Forced air ventilation alone is sufficient to maintain safe entry;o Monitoring and inspection data required by this program is developed;o If an initial entry is needed to collect the data above, then it will be performed in

compliance with parts (d) through (k) of the OSHA PRCS regulation; ando The determinations and data required above are documented and available to

employees who enter the space.

Entry under the terms above must be performed in accordance with the following requirements:

Any condition making it unsafe to remove an entrance cover will be eliminated before the cover is removed;

When covers are removed, a barrier that will prevent an accidental fall through the opening and protect employees in the space from foreign objects entering the space will promptly guard the entrance; and

Before an employee enters the space, the internal atmosphere will be tested by a qualified person with a calibrated direct-reading instrument, for the following conditions in the order given:

o oxygen content;o combustible gases and vapors;o potential toxic air contaminants.

There may be no hazardous atmosphere within the space whenever any employee is inside the space;

Continuous forced air ventilation will be used as follows: o An employee may not enter the space until forced air ventilation has eliminated

any hazardous atmosphere.o Forced air ventilation will be directed to ventilate the immediate areas where an

employee is or will be, and will continue until all employees have left the space.

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o The air supply for the ventilation will be clean and may not increase the hazard.

The atmosphere within the space will be continuously monitored unless Company Name can demonstrate that equipment for continuous monitoring is not commercially available or periodic monitoring is sufficient. If continuous monitoring is used, Company Name will ensure that the monitoring equipment has an alarm that will notify all entrants if a specified atmospheric threshold is achieved, or that an employee will check the monitor with sufficient frequency to ensure that entrants have adequate time to escape. If continuous monitoring is not used, periodic monitoring will be performed. All monitoring must ensure that the continuous forced air ventilation is preventing the accumulation of a hazardous atmosphere.

If a hazardous atmosphere is detected during entry: o Each employee will leave the space immediately;o The space will be evaluated to determine how the hazardous atmosphere

developed; and o Measures will be implemented to protect employees from the hazardous

atmosphere before a subsequent entry. Before each entry, it will be verified that the space is safe for entry and that the measures

above have been taken, with a written certification giving the date, location of the space, and signature of the person providing the certification.  The certification shall be made available to each employee entering the space or to that employee's authorized representative. Refer to Appendix J for a copy of the Alternate Procedures Certification.

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Appendix J.Alternate Procedures Certification

Location of Space:Certifying Employee:Date:Entrance Cover(s)Conditions making it unsafe to remove entrance covers have been removed? YES NO Once cover is removed, entrance is guarded to prevent employees from falling into and foreign objects from entering the space? YES NO AIR MONITORINGOnly hazard is an actual or potentially hazardous atmosphere? YES NO Continuous forced air ventilation alone is sufficient to eliminate hazardous atmosphere? YES NO Pre-entrySubstance Monitored Permissible Levels          Monitoring ResultsTime monitored (put time)

Percent Oxygen

 Record the time

19.5% to 23.5% 

LEL/LFL   Under 10%  Toxic 1:   _____ PEL ____STEL  Toxic 2:   _____ PEL ____STEL  Toxic 3:   _____ PEL ____STEL  Toxic 4:   _____ PEL ____STEL  REMARKS:

 Periodic

Substance Monitored Permissible Levels          Monitoring Results

Time monitored (put time)

Percent Oxygen

 Record the time

19.5% to 23.5%             

LEL/LFL   Under 10%              

Toxic 1:   _____ PEL ____STEL              

Toxic 2:   _____ PEL ____STEL              

Toxic 3:   _____ PEL ____STEL              

Toxic 4:   _____ PEL ____STEL              

REMARKS:

 ID# Instrument(s) Used Model # or Type Serial#

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(For example:  oxygen meter, combustible gas indicator, etc.)

or Unit

       

       

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