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CONFINED SPACE ENTRY PERMIT <br /> DATE: DEPT. : TIME BEGIN: <br /> (8 HRS. MAX.) <br /> AREA/STRUCTURE ENTERING: TIME END: <br /> LOCATION: DESCRIPTION OF WORK: <br /> OUTSIDE CONTRACTORS: <br /> REQUIRED COMPLETED <br /> - YES NO YES NO <br /> 1. AREA/STRUCTURE DRAINED AND/OR PUMPED <br /> 2. SPACE VENTILATED <br /> 3. ALL DRAIN MECHANISMS (BREAKERS) OFF, TAGGED, <br /> AND TRIED (LOCKED IF EXCEEDS 8 HRS.) <br /> VALVES OFF OR OTHER DRIVE MECHANISMS SECURED <br /> 4. PROTECTIVE EQUIP14ENT <br /> • A. HARNESS AND LIFELINE ON PERSON ENTERING <br /> B. LIFELINE SECURED OUTSIDE OF AREA/STRUCTURE <br /> C. WORKER WEARING MONITOR <br /> D. HARD HAT FOR HEAD PROTECTION <br /> E. EYE AND FACE PROTECTION <br /> F. HAND PROTECTION <br /> G. HEARING PROTECTION <br /> H. FOOT PROTECTION <br /> I. RESPIRATORY PROTECTION <br /> 5. COMMUNICATIONS UNDERSTOOD WITH STAND-BY PERSON <br /> 6. NEAREST TELEPHONE AND/OR TWO-WAY RADIO NOTED <br /> 7. ATMOSPHERIC TESTS - INITIAL TESTS ON THE AIR 140NITOR: <br /> A. OXYGEN READING: TOXIC GAS READING: <br /> TWA READING: EXPLOSIVE GAS READING: <br /> TI14E (0.00/HR.): LEL READING (-3 TO 3): <br /> B. INITIAL TESTS IN CONFINED SPACE: <br /> AUDIO AND/OR VISUAL ALARM YES NO <br /> • IF YES, EXPLAIN WHAT ACTION TAKEN: <br /> 8. COPY OF CONFINED SPACE ENTRY POLICY ON JOB SITE YES NO <br />