CONFINED SPACE ENTRY PERMIT - QC

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Henry McCarthy
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1 PERMIT CONFINED SPACE ENTRY PERMIT - QC BENEFITS Entry permits are not specifically required under the SK OHS Regulation. However, all employers are required to have an entry plan in place for what are called hazardous confined spaces. Entry permits for hazardous confined spaces serve 2 vital purposes: 1. They ensure that only authorized workers are allowed to enter hazardous confined spaces; and 2. Entry permits are required by Quebec OHS Regulations for Industrial Establishments. HOW TO USE THE TOOL Perform a hazard assessment identifying all of the confined spaces at your worksite, the work that must be performed within the space and the specific hazards and potential hazards within each of those spaces, including: Atmospheric hazards; Hazards created by the type of work performed within the space; Entry and exit hazards; Human risk factors, e.g., the worker s medical condition, fatigue, claustrophobia, etc. and Other hazards. The assessment should also recommend measures to be taken to eliminate or control these hazards. List information about the hazards, the hazard control measures, the work to be done and other information on the permit. Ensure that permits are issued by a competent supervisor or other person on site who s familiar with the work and its dangers and in a position to judge if workers are qualified to enter the space. Don t allow anybody into the space without a proper permit. Once the entry occurs, refer to the permit as an indication of who s in the space and the safety measures being implemented. Retain the permit after workers leave the space as a record of entry. This Model Permit is based on a form from a Quebec municipality. You ll need to modify it to meet your own circumstances.

2 CONFINED SPACE ENTRY PERMIT QC Post Permit at Job Site Until Job Is Completed PART 1 Person issuing permit: Permit issued: Date: Time: Permit expires: Date: Time: Description of Location: Department Name: Street Address: Purpose of Entry: Supervisor(s) in Charge: Work to Be Performed in Space: Standby Personnel/Attendant: Name of Authorized Entrants: PART 2 PRE-ENTRY CHECKLIST YES NO

3 Has the surrounding area been surveyed and found free of atmospheric hazards? Is the work area likely to remain free of any dangerous air contaminants? Have all personnel in the designated work area been briefed on paper work procedure, location of communications and who to contact in an emergency? Do all areas of work and machinery have some type of lockout and tagout installed in the proper place? Will testing be done continuously while the space is occupied? Is all safety equipment to be used in good condition and proper working order? INSTRUCTIONS: Entry IS NOT PERMITTED unless all of the answers to the questions above are YES PART 3 ENTRY, STANDBY & BACK-UP PERSONS YES NO Successfully completed required training? Is their training current? TRAINING: Are you and all personnel trained in: First Aid, CPR? Confined Space Entry? Did you and all personnel: Receive a pre-entry briefing on the plan to follow while in the confined space?

4 Receive a pre-entry briefing on selecting and using PPE in the confined space? Receive a pre-entry briefing on emergency rescue procedures? Has/Have the: Testing equipment been properly calibrated? Confined space/area been tested by a qualified person? The confined space area been assessed for: Atmospheric contaminants, including gases, vapours, fumes dusts or mists? Oxygen level to verify it s between 19.5% and 23%? Tested for the accumulation of flammable, combustible or explosive agents? Potential hazards of conductive heat transfer been evaluated? Any Hot Work considerations been assessed: Have Hot Work signs been posted? Have a permit been approved and posted? Has the Hot Work procedure been communicated? Space Preparation Methods (check off all that apply): Drained Flushed Steamed Barricaded Inerted Purged Ventilated Other (specify): Rescue System YES NO Is all the rescue equipment identified in the plan available and in good working order? Have all workers received training on equipment to be used during an emergency? Safety Equipment (check off all that apply) Cellular radio Harness Retrieval/Lifeline

5 Gas monitor Hoisting Equipment Safety harness & lifelines for entry & standby persons Eye Wash Intrinsically Safe Equip SCBA for entry & standby pers. First Aid Kit Non-spark Tools Statically Grounded Foot Protection Powered Communics Traffic Control GFCI Protective Clothing Tripod/Winch Hand Protection Radio Wristlets Hard Hat Respiratory Protection Other (specify): 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 it contains. We have received and understood written instructions and safety procedures. Note: Entry may not be approved if any of the columns in Part 2 above are marked NO. Print Name Signature Permit prepared by: Permit approved by:

6 Additional Workers/Supervisors Present:

SAFETY AND HEALTH STANDARD CONFINED SPACE ENTRY REQUIREMENTS Effective Date: 06/10/10 Standard: 16.2 Document Number: KUCSH0038 Rev: 07

SAFETY AND HEALTH STANDARD CONFINED SPACE ENTRY REQUIREMENTS Effective Date: 06/10/10 Standard: 16.2 Document Number: KUCSH0038 Rev: 07 16.2.1 INTRODUCTION 16.2.1.1 The purpose of this standard is to establish safety requirements, which include a permit system, for entry into confined spaces. 16.2.2 DEFINITIONS 16.6.2.1 Confined space