Confined Space Check List

Including How to Do CPR on an Adult

CPR Photos and Instructions Bottom section of this PDF

In addition to this training, rescue team members also require training in CPR and first aid. Employers

must certify that this training has been provided.

Trained in CPR \Name _______________________________ Date__________

Certificate Number___________________________

Confined Space Entry Permit

Date and Time Issued: _______________ Date and Time Expires: ________

Job site/Space I.D.: ________________ Job Supervisor:________________

Equipment to be worked on: __________ Work to be performed: _________

Stand-by personnel: __________________ ________________ _____________

1. Atmospheric Checks: Time ________

Oxygen ________%

Explosive ________% L.F.L.

Toxic ________PPM

2. Tester's signature: _____________________________

3. Source isolation (No Entry): N/A Yes No

Pumps or lines blinded, ( ) ( ) ( )

disconnected, or blocked ( ) ( ) ( )

4. Ventilation Modification: N/A Yes No

Mechanical ( ) ( ) ( )

Natural Ventilation only ( ) ( ) ( )

5. Atmospheric check after

isolation and Ventilation:

Oxygen __________% > 19.5 %

Explosive _______% L.F.L < 10 %

Toxic ___________PPM < 10 PPM H(2)S

Time ____________

Testers signature: _____________________________

6. Communication procedures: ________________________________________

_____________________________________________________________________

7. Rescue procedures: _______________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

8. Entry, standby, and back up persons: Yes No

Successfully completed required

training?

Is it current? ( ) ( )

9. Equipment: N/A Yes No

Direct reading gas monitor -

tested ( ) ( ) ( )

Safety harnesses and lifelines

for entry and standby persons ( ) ( ) ( )

Hoisting equipment ( ) ( ) ( )

Powered communications ( ) ( ) ( )

SCBA's for entry and standby

persons ( ) ( ) ( )

Protective Clothing ( ) ( ) ( )

All electric equipment listed

Class I, Division I, Group D

and Non-sparking tools ( ) ( ) ( )

10. Periodic atmospheric tests:

Oxygen ____% Time ____ Oxygen ____% Time ____

Oxygen ____% Time ____ Oxygen ____% Time ____

Explosive ____% Time ____ Explosive ____% Time ____

Explosive ____% Time ____ Explosive ____% Time ____

Toxic ____% Time ____ Toxic ____% Time ____

Toxic ____% Time ____ Toxic ____% Time ____

We have reviewed the work authorized by this permit and the

information contained here-in. Written instructions and safety

procedures have been received and are understood. Entry cannot be

approved if any squares are marked in the "No" column. This permit is

not valid unless all appropriate items are completed.

Permit Prepared By: (Supervisor)________________________________________

Approved By: (Unit Supervisor)__________________________________________

Reviewed By (Cs Operations Personnel) :

_________________________________ ____________________________________

(printed name) (signature)

This permit to be kept at job site. Return job site copy to Safety

Office following job completion.

Copies: White Original (Safety Office)

Yellow (Unit Supervisor)

Hard(Job site)

Appendix D - 2

ENTRY PERMIT

PERMIT VALID FOR 8 HOURS ONLY. ALL COPIES OF PERMIT WILL REMAIN AT

JOB SITE UNTIL JOB IS COMPLETED

DATE: - - SITE LOCATION and DESCRIPTION ______________________________

PURPOSE OF ENTRY ______________________________________________________

SUPERVISOR(S) in charge of crews Type of Crew Phone #

_______________________________________________________________________

_______________________________________________________________________

COMMUNICATION PROCEDURES ______________________________________________

RESCUE PROCEDURES (PHONE NUMBERS AT BOTTOM) ___________________________

_______________________________________________________________________

* BOLD DENOTES MINIMUM REQUIREMENTS TO BE COMPLETED AND REVIEWED

PRIOR TO ENTRY*

REQUIREMENTS COMPLETED DATE TIME

Lock Out/De-energize/Try-out ____ ____

Line(s) Broken-Capped-Blanked ____ ____

Purge-Flush and Vent ____ ____

Ventilation ____ ____

Secure Area (Post and Flag) ____ ____

Breathing Apparatus ____ ____

Resuscitator - Inhalator ____ ____

Standby Safety Personnel ____ ____

Full Body Harness w/"D" ring ____ ____

Emergency Escape Retrieval Equip ____ ____

Lifelines ____ ____

Fire Extinguishers ____ ____

Lighting (Explosive Proof) ____ ____

Protective Clothing ____ ____

Respirator(s) (Air Purifying) ____ ____

Burning and Welding Permit ____ ____

Note: Items that do not apply enter N/A in the blank.

**RECORD CONTINUOUS MONITORING RESULTS EVERY 2 HOURS

CONTINUOUS MONITORING** Permissible _________________________________

TEST(S) TO BE TAKEN Entry Level

PERCENT OF OXYGEN 19.5% to 23.5% ___ ___ ___ ___ ___ ___ ___ ___

LOWER FLAMMABLE LIMIT Under 10% ___ ___ ___ ___ ___ ___ ___ ___

CARBON MONOXIDE +35 PPM ___ ___ ___ ___ ___ ___ ___ ___

Aromatic Hydrocarbon + 1 PPM * 5PPM ___ ___ ___ ___ ___ ___ ___ ___

Hydrogen Cyanide (Skin) * 4PPM ___ ___ ___ ___ ___ ___ ___ ___

Hydrogen Sulfide +10 PPM *15PPM ___ ___ ___ ___ ___ ___ ___ ___

Sulfur Dioxide + 2 PPM * 5PPM ___ ___ ___ ___ ___ ___ ___ ___

Ammonia *35PPM ___ ___ ___ ___ ___ ___ ___ ___

* Short-term exposure limit: Employee can work in the area up to 15

minutes.

+ 8 hr. Time Weighted Avg.: Employee can work in area 8 hrs (longer

with appropriate respiratory protection).

REMARKS:_____________________________________________________________

GAS TESTER NAME INSTRUMENT(S) MODEL SERIAL &/OR

& CHECK # USED &/OR TYPE UNIT #

________________ _______________ ___________ ____________

________________ _______________ ___________ ____________

SAFETY STANDBY PERSON IS REQUIRED FOR ALL CONFINED SPACE WORK

SAFETY STANDBY CHECK # CONFINED CONFINED

PERSON(S) SPACE CHECK # SPACE CHECK #

ENTRANT(S) ENTRANT(S)

______________ _______ __________ _______ __________ _______

______________ _______ __________ _______ __________ _______

SUPERVISOR AUTHORIZING - ALL CONDITIONS SATISFIED____________________

DEPARTMENT/PHONE ___________________________

AMBULANCE 2800 FIRE 2900 Safety 4901 Gas Coordinator 4529/5387

Job Description

Written Programs

Any employer who allows employee entry into a permit space must develop and implement a written

program for the space. Among other things, the OSHA standard requires the employer's written

program to:

Implement necessary measures to prevent unauthorized entry;

Identify and evaluate permit space hazards before allowing employee entry;

Test atmospheric conditions in the permit space before entry operations and monitor the space

during entry;

Perform appropriate testing for the following atmospheric hazards in this sequence: oxygen,

combustible gases or vapors, and toxic gases or vapors;

Establish and implement the means, procedures and practices to eliminate or control hazards

necessary for safe permit space entry operations;

Identify employee job duties;

Provide and maintain, at no cost to the employee, personal protective equipment and any other

equipment necessary for safe entry and require employees to use it;

Ensure that at least one attendant is stationed outside the permit space for the duration of entry

operations;

Coordinate entry operations when employees of more than one employer are working in the permit

space;

Implement appropriate procedures for summoning rescue and emergency services, and preventing

unauthorized personnel from attempting rescue;

Establish, in writing, and implement a system for the preparation, issue, use and cancellation of entry

permits;

Review established entry operations annually and revise the permit space entry program as

necessary; and

Implement the procedures that any attendant who is required to monitor multiple spaces will follow

during an emergency in one or more of those spaces.

Controlling Hazards

The employer's written program should establish the means, procedures and practices to eliminate or

control hazards necessary for safe permit space entry operations. These may include:

Specifying acceptable entry conditions;

Isolating the permit space;

Providing barriers;

Verifying acceptable entry conditions; and

Purging, making inert, flushing or ventilating the permit space.

Equipment for safe entry

In addition to personal protective equipment, other equipment that employees may require for safe

entry into a permit space includes:

Testing, monitoring, ventilating, communications and lighting equipment;

Barriers and shields;

Ladders; and

Retrieval devices.

Detection of hazardous conditions

If hazardous conditions are detected during entry, employees must immediately leave the space. The

employer must evaluate the space to determine the cause of the hazardous atmosphere and modify

the program as necessary.

When entry to permit spaces is prohibited, the employer must take effective measures to prevent

unauthorized entry. Non-permit confined spaces must be evaluated when changes occur in their use

or configuration and, where appropriate, must be reclassified as permit spaces.

A space with no potential to have atmospheric hazards may be classified as a non-permit confined

space only when all hazards are eliminated in accordance with the standard. If entry is required to

eliminate hazards and obtain data, the employer must follow specific procedures in the standard.

Assigned Duties

Authorized entrant

Authorized entrants are required to:

Know space hazards, including information on the means of exposure such as inhalation or dermal

absorption, signs of symptoms and consequences of the exposure;

Use appropriate personal protective equipment properly;

Maintain communication with attendants as necessary to enable them to monitor the entrant's status

and alert the entrant to evacuate when necessary;

Exit from the permit space as soon as possible when:

Ordered by the authorized person;

He or she recognizes the warning signs or symptoms of exposure;

A prohibited condition exists; or

An automatic alarm is activated.

Alert the attendant when a prohibited condition exists or when warning signs or symptoms of exposure

exist.

Attendant

The attendant is required to:

Remain outside the permit space during entry operations unless relieved by another authorized

attendant;

Perform non-entry rescues when specified by the employer's rescue procedure;

Know existing and potential hazards, including information on the mode of exposure, signs or

symptoms, consequences and physiological effects;

Maintain communication with and keep an accurate account of those workers entering the permit

space;

Order evacuation of the permit space when:

A prohibited condition exists;

A worker shows signs of physiological effects of hazard exposure;

An emergency outside the confined space exists; and

The attendant cannot effectively and safely perform required duties.

Summon rescue and other services during an emergency;

Ensure that unauthorized people stay away from permit spaces or exit immediately if they have entered

the permit space;

Inform authorized entrants and the entry supervisor if any unauthorized person enters the permit

space; and

Perform no other duties that interfere with the attendant's primary duties.

Entry supervisor

Entry supervisors are required to:

Know space hazards including information on the mode of exposure, signs or symptoms and

consequences;

Verify emergency plans and specified entry conditions such as permits, tests, procedures and equipment

before allowing entry;

Terminate entry and cancel permits when entry operations are completed or if a new condition exists;

Verify that rescue services are available and that the means for summoning them are operable;

Take appropriate measures to remove unauthorized entrants; and

Ensure that entry operations remain consistent with the entry permit and that acceptable entry

conditions are maintained.

In 2010, the American Heart Association made a radical change to the recommended CPR process for

victims of cardiac arrest[1] after studies showed that compression-only CPR (no mouth-to-mouth

breathing) is as effective as the traditional approach. Here's how to perform both methods of CPR on an

adult.

Steps

1

Check the scene for immediate danger. Make sure you're not putting yourself in harm's way by

administering CPR to someone unconscious. Is there a fire? Is the person lying on a roadway? Do

whatever is necessary to move yourself and the other person to safety.

CPR Recertification Get Recertified Online Today At ProCPR. Begin Now For Free!

www.ProCPR.org If there is anything that could endanger you or the victim, see if there is something you

can do to counteract it. Open a window, turn off the stove, or put out the fire if possible.

However, if there is nothing you can do to counteract the danger, move the victim. The best way to

move the victim is by placing a blanket or coat underneath their back and dragging it.

2Assess the victim's consciousness. Gently tap his or her shoulder and ask "Are you OK?" in a loud, clear

voice. If he or she responds, CPR is not required. Instead, undertake basic first aid and take measures to

prevent or treat shock[1], and assess whether you need to contact emergency services.

If the victim does not respond, continue with the following steps.

3 Send for help. The more people available for this step, the better. However, it can be done alone.

Send someone to call for emergency medical services (EMS).

Give the dispatcher your location, and notify him or her that you're going to perform CPR. If you're

alone, get off the phone and start compressions after that. If you have someone else with you, have him

or her stay on the line while you do CPR on the victim.

4

Do not check for a pulse. If you're not a trained medical professional, odds are you'll spend too much

valuable time looking for a pulse when you should be doing compressions.[2]

5

Check for breathing. Put your ear close to the victim's nose and mouth, and listen for slight breathing. If

the victim is coughing or breathing normally, do not perform CPR. Doing so could cause the heart to stop

beating. [3]

6

Place the victim on his or her back. Make sure he or she is lying as flat as possible - this will prevent

injury while you're doing chest compressions.

7

Place the heel of one hand on the victim's breastbone, exactly between the nipples.

8

Place your second hand on top of the first hand, palm-down.

9

Position your body directly over your hands, so that your arms are straight and somewhat rigid.

10

Perform 30 chest compressions. Press down with both hands directly over the breastbone to perform a

compression, which helps the heart beat. Chest compressions are more critical for correcting abnormal

heart rhythms (ventricular fibrillation or pulseless ventricular tachycardia).

You should press down by about 2 inches (5 cm).[4]

Do the compressions in a relatively fast rhythm. Some agencies recommend doing compressions to the

beat of the chorus of "Stayin' Alive," a 1970s disco hit, or at roughly 103 beats per minute. (You can

listen to it here.)

11

Minimize pauses in chest compression that occur when changing providers or preparing for a shock.[1]

Attempt to limit interruptions to less than 10 seconds. [4]

12

Make sure the airway is open. Place your hand on the victim's forehead and two fingers on their chin

and tilt the head back to open the airway.

If you suspect a neck injury, pull the jaw forward rather than lifting the chin. If jaw thrust fails to open

the airway, do a careful head tilt and chin lift.

If there are no signs of life, place a breathing barrier (if available) over the victim's mouth.

13

Give two rescue breaths (optional). The American Heart Association no longer considers rescue breaths

necessary for CPR, as the chest compressions are more important. You can give them if you choose to,

though.

Keeping the airway open, take the fingers that were on the forehead and pinch the victim's nose closed.

Make a seal with your mouth over the victim's mouth and breathe out for about one second. Make sure

you breathe slowly, as this will make sure the air goes in the lungs and not the stomach.

If the breath goes in, you should see the chest slightly rise and also feel it go in. Give a second rescue

breath.

If the breath does not go in, re-position the head and try again. If it does not go in again, the victim may

be choking. Do abdominal thrusts (the Heimlich manuever) to remove the obstruction.

14

Repeat the cycle of 30 chest compressions. If you're also doing rescue breaths, keep doing a cycle of 30

chest compressions and 2 rescue breaths.

You should do CPR for 2 minutes (5 cycles of compressions to breaths) before checking for signs of life.

15

Continue CPR until someone takes over for you, emergency personnel arrive, you are too exhausted to

continue, an AED is available for immediate use, or signs of life return.

16

Use an AED (automated external defibrillator). If an AED is available in the immediate area, use it as

soon as possible to jump-start the victim's heart. [5]

Make sure there are no puddles or standing water in the immediate area.

Turn on the AED. It should have voice prompts that tell you what to do.

Fully expose the victim's chest. Remove any metal necklaces or underwire bras.

Check for any body piercings, or evidence that the victim has a pacemaker or implantable cardioverter

defibrillator (should be indicated by a medical bracelet).

Make sure the chest is absolutely dry. Note that if the person has a lot of chest hair, you may need to

shave it. Some AED kits come with razors for this purpose.

Attach the sticky pads with electrodes to the victim's chest. Follow the instructions on the AED for

placement. Move the pads at least 1 inch (2.5 cm) away from any metal piercings or implanted devices.

Make sure no one is touching the person.

Press analyze on the AED machine. If a shock is needed, the machine will notify you.

If you do shock the victim, make sure no one is touching him or her.

Remove the electrode pads and resume CPR for another 5 cycles before using the AED again.