CONFINED SPACE ENTRY PROCEDURES

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--- PERMIT AND PLANNING ---
[ ] Permit Issue Date
[ ] Permit Issue Time
[ ] Description of Confined Space
[ ] Purpose of Entry
[ ] Detailed Entry Procedures
[ ] Authorized Entry Personnel (Names/IDs)
[ ] Attendant/Monitor Name/ID
[ ] Maximum Entry Time (Hours)
[ ] Potential Hazards Identified
[ ] Permit Authorizer Signature

--- HAZARD IDENTIFICATION AND EVALUATION ---
[ ] Describe the Confined Space (e.g., grain bin, fertilizer tank, silo)
[ ] Potential Atmospheric Hazards Present? (Oxygen Deficiency, Toxic Gases (e.g., Hydrogen Sulfide, Carbon Monoxide), Flammable Gases/Vapors, Dust Explosion Hazard, None Identified)
[ ] Describe any physical hazards present (e.g., entanglement, suffocation, falling)
[ ] Potential Energy Sources? (Mechanical (Augers, Conveyors), Electrical, Hydraulic, Gravity (Falling Materials), None Identified)
[ ] Describe any other hazards identified (e.g., biological, ergonomic)
[ ] Estimated Depth/Height of Confined Space (feet/meters)
[ ] Hazard Severity Ranking (Low, Medium, High) (Low, Medium, High)

--- CONFINED SPACE ATMOSPHERE TESTING ---
[ ] Initial Atmosphere Testing Time
[ ] Oxygen Level (%)
[ ] Flammable Gas Level (ppm)
[ ] Hydrogen Sulfide (H2S) Level (ppm)
[ ] Atmosphere Test Results - Safe? (Yes, No)
[ ] Notes on Atmosphere Testing (if not safe)
[ ] Re-testing Interval
[ ] Carbon Monoxide (CO) Level (ppm)

--- VENTILATION AND AIR SUPPLY ---
[ ] Ventilation Method Selected (Forced Air Ventilation, Natural Ventilation, Both (Combination))
[ ] Airflow Rate (CFM) - Forced Ventilation
[ ] Air Supply Source (Compressed Air, Oxygen-Enriched Air, Ambient Air)
[ ] Oxygen Level (Percentage)
[ ] Carbon Monoxide (CO) Level (ppm)
[ ] Ventilation Procedure Notes
[ ] Air Supply Line Integrity Verified? (Yes, No)
[ ] Ventilation System Last Inspection Date

--- ISOLATION AND LOCKOUT/TAGOUT ---
[ ] Identify Energy Sources (Mechanical (e.g., augers, conveyors), Electrical, Hydraulic, Pneumatic, Gravity, Process (e.g., grain flow), Other (Specify in LONG_TEXT))
[ ] Describe 'Other' Energy Sources (if selected)
[ ] Lockout/Tagout Procedures Completed? (Disengaged Mechanical Equipment, De-energized Electrical Circuits, Depressurized Hydraulic/Pneumatic Lines, Blocked/Diverted Flow, Verified Zero Energy State)
[ ] Pressure Reading (if applicable)
[ ] Lockout Device Placement (On Equipment Disconnect, On Valve, On Main Power Supply, Other (LONG_TEXT))
[ ] Describe 'Other' Lockout Device Placement (if selected)
[ ] Verify Lockout/Tagout Effectiveness (Attempt to Energize/Activate Equipment, Visual Inspection, Other (LONG_TEXT))
[ ] Describe 'Other' Verification Methods (if selected)

--- ENTRY PERSONNEL & ROLES ---
[ ] Entry Supervisor Designation (Designated, Not Designated)
[ ] Entry Supervisor Name
[ ] Entry Team Leader Name
[ ] Entry Team Member(s) - Indicate all who are entering (Team Member 1, Team Member 2, Team Member 3, Team Member 4)
[ ] Attendant/Monitor Designated? (Yes, No)
[ ] Attendant/Monitor Name (if applicable)
[ ] Brief Description of Roles & Responsibilities for Entry Team

--- ATTENDANT RESPONSIBILITIES ---
[ ] Describe the Attendant's Primary Responsibility
[ ] Attendant Trained in Confined Space Rescue? (Yes, No)
[ ] Distance of Attendant from Confined Space Entry (feet)
[ ] Scheduled Rotation Time (if applicable)
[ ] Describe the Communication Method Used (e.g., radio, verbal)
[ ] Attendant has clear view of entrants? (Yes, No)
[ ] Describe any unusual noises or conditions observed outside the confined space.

--- COMMUNICATION ---
[ ] Primary Communication Method (Two-Way Radio, Verbal Communication (Visual Signals), Rope Signal System, Other (Specify in LONG_TEXT))
[ ] Detailed Communication Plan
[ ] Radio Channel/Frequency (if applicable)
[ ] Signal Person Position (Adjacent to Entryway, Elevated Position, Designated Monitor Location)
[ ] Emergency Communication Protocol
[ ] Backup Communication Method (Two-Way Radio (Different Frequency), Visual Hand Signals, Voice Carry, None)
[ ] Last Communication Check Time

--- PERSONAL PROTECTIVE EQUIPMENT (PPE) ---
[ ] Required PPE - Head Protection (Hard Hat (ANSI Z89.1), Bump Cap, N/A - Not Required, Other (Specify))
[ ] Required PPE - Eye/Face Protection (Safety Glasses (ANSI Z87.1), Goggles, Face Shield, N/A - Not Required, Other (Specify))
[ ] Required PPE - Respiratory Protection (N/A - Atmosphere Safe, Supplied Air Respirator (SAR), Air-Purifying Respirator (APR) â€“ Cartridge Type, Self-Contained Breathing Apparatus (SCBA), Other (Specify) - Requires Approval)
[ ] Required PPE - Hand Protection (Gloves (Specify Material - e.g., Nitrile, Latex), N/A - Not Required, Other (Specify))
[ ] Required PPE - Body Protection (Coveralls, Protective Suit, High-Visibility Vest/Clothing, N/A - Not Required, Other (Specify))
[ ] Fit Testing Status (Respiratory) (Fit Tested within Last 12 Months, Fit Testing Required, N/A - No Respiratory Protection Required)

--- RETRIEVAL AND EMERGENCY PROCEDURES ---
[ ] Describe the retrieval plan, including equipment and techniques.
[ ] Maximum Retrieval Time (minutes)
[ ] Retrieval Equipment Available (Check all that apply) (Tripod/Davits, Winches, Harnesses, Lifelines, Other (Specify))
[ ] Emergency Contact Information (Name, Phone)
[ ] Emergency Scenarios Considered (Check all that apply) (Atmospheric Hazard, Entrapment, Equipment Failure, Medical Emergency, Other (Specify))
[ ] Describe emergency escape routes and procedures.
[ ] Date of last emergency drill
[ ] Estimated time to summon emergency services

--- POST-ENTRY PROCEDURES ---
[ ] Entry Exit Time
[ ] Observations During Entry (Deviations, Concerns, etc.)
[ ] Permit Status (Completed, Revised, Cancelled)
[ ] Oxygen Meter Reading (Post-Entry)
[ ] Equipment Condition After Use (Good, Needs Repair, Damaged)
[ ] Notes Regarding Equipment Condition
[ ] Permit Expiration Date Verified
[ ] Permit Revalidation Needed? (Yes, No)

--- END OF TEMPLATE ---
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