Confined Spaces. Risk Management Services

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2 Table of Contents I. Program Goals and Objectives... 2 II. Scope and Application... 2 III. Responsibilities... 2 IV. Training... 4 V. Signage... 4 VI. Communication... 5 VII. Air Monitoring Instrumentation... 5 VIII. Rescue... 5 IX. Reclassification and Alternate Entry Procedures... 6 X. Recordkeeping... 7 XI. Regulatory Authority... 7 XII. Contact... 7 Appendix 1 Confined Space Assessment Instructions... 8 Appendix 2 Confined Space Assessment Form... 9 Appendix 3 General Confined Space Entry Guidelines Appendix 4 Confined Space Entry Permit Appendix 5 Confined Space Reclassification Form Appendix 6 Confined Space Alternate Entry Form Appendix 7 Bump Test Log Sheet

3 I. Program Goals and Objectives This program establishes a process to protect employees from the hazards associated with the entry into confined spaces and provides guidance for the safe access, entry, and egress of confined spaces. II. Scope and Application This program applies to all Northwestern employees and contractors working in confined spaces. A. Definition Confined spaces are defined as areas that: 1. Are large enough for an employee to enter and perform work 2. Have limited or restricted means for entry or exit, and 3. Are not designed for continuous occupancy Examples of confined spaces at Northwestern are sewers, manholes, tunnels, tanks, boilers, transformers, pipes, excavations, elevator pits, vaults, and ducts. For the purpose of this program, there are two classifications of confined spaces: Non-permit required confined space Permit required confined space B. Evaluation Conduct assessments to determine whether a confined space is classified as a nonpermit required confined space or a permit required confined space. When there are changes in the use or configuration of a non-permit confined space, or when certain operations (e.g. welding, steam lines, chemicals) that might introduce or create new hazards to entrants, the confined space shall be re-evaluated prior to entry. If necessary, the space will be reclassified as a permit-required confined space. Refer to Appendix 1 for assessment instructions and Appendix 2 for the assessment form. III. Responsibilities C. i. Review, audit, and revise this program and permit process annually or anytime deemed necessary. ii. In collaboration with Facilities Management, assess new and existing confined spaces. iii. Provide guidance and technical assistance as needed. D. Facilities Management Operations i. Prior to entry into a confined spaces, conduct assessments to determine hazards and if a permit is required. 2

4 ii. Communicate all findings from confined space assessments with all employees or contractors involved or affected. iii. Department chief, supervisor, or designee to approve entry into permit required confined spaces. iv. Ensure employees are fully informed, authorized, and trained in confined space entry requirements and procedures as outlined in this program. v. Prevent unauthorized entry into permit required confined spaces through training, signage, and security measures. vi. Monitor employees need for additional or refresher training, based upon assigned duties, changes in confined spaces, or changes to this program. vii. Collaborate with to assure that contractor s Confined Space Program and permit process is compliant with regulatory requirements. E. Project Managers i. Inform contractors of work that involves any confined space entry and provide assessments for those spaces. ii. Collaborate with Facilities Management when energy shutdowns or lifesaving impairments are necessary. iii. Collaborate with to assure that contractor s Confined Space Program and permit process is compliant with regulatory requirements. iv. Inform and provide contractors with the Northwestern Confined Space Program and specific procedures developed for confined space entries. F. Authorized Entry Supervisors, Attendants, and Entrants i. Successfully complete confined space entry training. ii. Conduct assigned tasks in a safe manner at all times. iii. Wear appropriate personal protective equipment. iv. Report any injuries, illnesses, questions, or any unsafe working conditions to Departmental Supervisor. G. Contractors i. Provide a copy of a site specific/project specific confined spaced program to Northwestern Project Managers and ; this program must meet or exceed the minimum requirements set forth in this program in addition to the in Construction regulations if applicable. ii. Obtain copies of all necessary confined space assessments and coordinate all confined space entries with Facilities Management; this includes entry when both Northwestern personnel and contractor personnel will be working in or near confined spaces. iii. Ensure that employees are properly trained in confined space entries. iv. Provide the necessary equipment, PPE, personnel, and resources necessary for safe entry into confined spaces, including air-monitoring equipment. v. Post permits at confined space entry sites for the duration of the entry. 3

5 vi. vii. viii. Inform Northwestern Project Manager of any hazards confronted or created in the confined space. Develop rescue procedures specific to the space(s) entered. Effective means of rescue must be in place by use of a non-entry retrieval system, such as a tripod, winch, lifeline, and body harness. If a non-entry retrieval system will be ineffective for entrant rescue, a rescue team must be on standby outside the space with all necessary tools and equipment to perform an entry rescue, if needed. In the event of an emergency requiring confined space rescue, the authorized entry supervisor or attendant will immediately notify emergency services as indicated in Appendix 3. IV. Training A. Responsibility Departments are responsible for ensuring employees are properly trained and proficient in the duties required for confined space entry. Additional training is required when procedures are updated or a new hazard exists. B. Requirements Confined space entry training is required: i. Before an employee is initially assigned a task involving a confined space as a supervisor, entrant, or attendant ii. Whenever there is a change in a confined space that presents hazards(s) to which the employee has not been previously trained iii. If there are observed inadequacies in an employee s knowledge or execution of confined space procedures C. Refresher Training Confined space refresher training is required every 3 years for all employees involved in confined space operations. V. Signage A. Requirements For all permit-required confined spaces, post appropriate signage at the entry portal, hatch, cover, or equally effective location. B. Outdoor manhole covers and hatches i. Outdoor manhole covers and hatches for permit-required confined spaces are not required to have signage, as long as access points are kept locked or require special tools, such as a cro-bar or pry-bar, to open. ii. Number all access points to permit-required confined spaces that do not have posted signage in a conspicuous manner, such as with paint, tag, or other effective means, for identification purposes. 4

6 VI. Communication Departments and contractors must ensure that two-way communication is available during all permit-required confined space entries and are responsible for ensuring adequate communication: i. Between those inside the confined space ii. Between those inside the confined space and those outside iii. To summon emergency responders in the event of an emergency Examples of acceptable forms of communication are: i. UHF portable radio ii. Cellular phone iii. Verbal iv. Tapping v. Fixed telephone, if available vi. Visual (e.g.: hand signals) vii. Tugs on a lifeline Cellular service and UHF radio coverage may be limited in certain confined spaces at Northwestern. Effective communication is required for all permit-required confined space entries. VII. Air Monitoring Instrumentation Departments are responsible for maintaining, calibrating, and operating all air monitoring equipment according to the manufacturer s instructions. i. Prior to performing air monitoring for permit-required confined space entry, perform a bump test or full calibration in accordance with the manufacturer s instructions using ii. iii. the appropriate test gas. Adjust any instrument that fails a bump test by a full calibration before further use. Calibration of air monitoring equipment must be performed monthly and documented. Atmospheric conditions must remain within the following limits while workers are in the space: i. Oxygen: ii. Lower Explosive Limit (LEL): < 10 iii. Carbon Monoxide (CO): < 35 PPM (Parts per Million) iv. Hydrogen Sulfide (H2S): < 10 PPM (Parts per Million) VIII. Rescue A. Rescue Procedures i. Rescue procedures are required for all permit-required confined space entries. ii. If an entrant requires rescue from a confined space, the Entry Supervisor or Attendant shall always notify the Department of Safety and Security (formerly Northwestern University Police) immediately. 5

7 B. Rescue Methods There are two types of rescue: entry and non-entry. i. Trained rescue professionals can only perform entry rescue. ii. Trained attendants and entry supervisors may perform non-entry rescue with the use of a retrieval system. C. Rescue Method Selection i. Retrieval systems, such as tripods, shall be set-up and used whenever an employee enters a permit-required confined space to facilitate non-entry rescue, if needed. ii. Retrieval systems shall include a chest or full body harness, retrieval line, and a mechanical retrieval device (if the vertical space is over 5 feet deep). iii. The retrieval system is not required if the equipment would increase the overall risk of entry or would not contribute to the rescue of the entrant. iv. If non-entry retrieval equipment will not be effective, a means of entry rescue must be in place, such as a standby rescue team with SCBA s. Northwestern employees are not permitted to enter a confined space to perform a rescue under any circumstances. IX. Reclassification and Alternate Entry Procedures A. Reclassification i. Temporary entry into a permit-required confined space without the use of a ii. iii. iv. permit may be allowed, if certain criteria are met. If no actual or potential atmospheric hazards are present, and all other serious hazards are eliminated, the space may be temporarily entered using the reclassification form in Appendix 5. Entry operations are immediately canceled when the work is completed, a condition that is not allowed under the form arises, or after 8 hours. Re-entry into the space requires a permit or new reclassification form. The reclassification form may not be used at the following locations: a. Evanston campus lift stations b. Evanston Central Utility Plant c. Chicago Utility Plant B. Alternate Entry Procedures has determined there are no permit-required confined spaces at Northwestern that meet the criteria for using alternate entry procedures. However, in the rare circumstance that a space becomes eligible for using alternate entry procedures, written approval and authorization is required from and the Entry Supervisor. Refer to Appendix 6 for the alternate entry procedures form. 6

8 X. Recordkeeping Departments are responsible for maintaining confined space records. i. Entry permits and forms shall be retained for at least three years. ii. Air monitoring instrument records (bump tests, calibrations, and service repairs) must be retained for at least three years. Electronic means, such as instrument software, may be used to record this information in lieu of paper logs, if available. Refer to Appendix 7 for an example of a bump test log sheet. iii. Facilities Management shall be responsible for maintaining the confined space assessments, either electronically or in a hard copy format. Assessments shall be kept readily available as long as they are valid and accurate. Any new assessments or changes to existing assessments shall be included as necessary. iv. Departments are responsible for maintaining employee training records and must be kept for a minimum of three years; records must include employees names, trainers signatures or initials, and dates of training. XI. Regulatory Authority Northwestern and contractors will comply with the Occupational Health and Safety Administration s (OSHA) standards and any other applicable codes and standards. 29 Code of Federal Regulations (CFR) Part Permit-Required 29 Code of Federal Regulations (CFR) Part 1926 Subpart AA in Construction XII. Contact For questions, contact, Gwen Butler at gwen.butler@northwestern.edu (847)

9 Appendix 1 Confined Space Assessment Instructions These instructions address how to conduct a Confined Space Assessment. The purpose is to determine if a space is non-permit required space or a permit required confined space. This assessment does not replace the required Confined Space Permit, but provides guidance for the safe entry into at Northwestern. Take into account the work that will be performed and decide if the work itself will create a hazard. Step 1: Confined Space Determination: Section A Determine if the space is a Confined Space. Confined spaces are defined as areas that: 1. Are large enough for an employee to enter and perform work 2. Have limited or restricted means for entry or exit, and 3. Are not designed for continuous occupancy If NO is answered to any question in Section A, no further assessment is required as the area would not qualify as a Confined Space. Step 2: Permit-Required Determination: Section B Determine if the Confined Space qualifies as a Permit-Required Space. Take into account the work that will be performed and decide if the work itself will create a hazard. Hazard considerations in this section include: atmospheric, engulfment, work space configuration, entry and egress, ventilation requirements, and lifeline considerations. Step 3: Alternate Entry Determination: Section C Determine if alternate entry procedures may be used in the confined space. Information from Section B will be used to help determine if alternate entries are appropriate. Step 4: Final Determination: Section D Determine whether the work is Non-Permit Required, a Permit-Required Confined Space, or whether Alternate Entry Procedures can be used. If YES was marked for any hazards in section B items 2-4, then the space is a Permit-Required Confined Space. If the work being conducted is considered a Permit-Required Confined Space, proceed to Appendix 4, Confined Space Entry Permit. 8

10 Appendix 2 Confined Space Assessment Form Confined Space Assessment Date of Assessment: Building: Type of Space: Conducted By: Space Location: Purpose of Entry: Section A: Confined Space Determination Yes No 1. The space is large enough and is so configured that an employee can bodily enter and perform assigned work. 2. The space has limited or restricted means of entry or exit. (i.e. tanks, vaults, vessels, silos, storage bins, hoppers, pits, diked areas) 3. The space is not designed for continuous employee occupancy. If you answered YES to all three of the questions above, then the space is considered a confined space. Proceed to Section B. If you answered NO to any one of the three questions above, the space is not a confined space, check the box below and proceed no further. The area does not qualify as a confined space. Section B: Permit-Required Confined Space Determination: Yes No 1. Does the space have or have the potential for a hazardous atmosphere? a. Oxygen Deficient (O 2 concentration below 19.5) If YES, please check the hazards(s) below: b. Oxygen Enriched (O 2 concentration at or above 23.5) c. Explosive Gas/Vapor d. H 2 S (Hydrogen Sulfide) e. CO (Carbon Monoxide) f. Cl 2 (Chlorine) g. Other: 9

11 Confined Space Assessment 2. Does the space have the potential to engulf or suffocate the entrant? If YES, please check the hazards(s) below: a. Sand b. Water c. Soil d. Gravel/Loose Rock e. Sewage f. Oil g. Other 3. Does the space have an internal configuration that an entrant could become trapped? If YES, please check the hazards(s) below: a. Converging walls/downward sloping floors b. Constriction/taper to a smaller cross-section c. Difficult to exit/ inadequate access / obstacles d. Other 4. Is there a potential for any other serious safety and health hazard? If YES, please check the hazards(s) below: a. Electrical b. Moving Parts c. Slips/Trips/Falls d. Hot/Cold Extremes e. Noise/Vibration f. Chemicals g. Skin/Eye Irritants h. Other 10

12 Confined Space Assessment 5. How is the space entered? a. Fixed Ladder b. Portable Ladder c. Stairs d. Lowering Winch(Separate from rescue escape) 6. Will ventilation be required in the space? If YES, please check the hazards(s) below: a. Natural b. Forced Positive c. Forced Negative 7. Will the entrant need to detach from the lifeline requiring rescue on site? Section C. Alternate Entry Procedure Determination Yes No 1. If any items 2-4 of Section B were marked YES, then alternate entry procedures are NOT allowed for the space. 2. Is the only hazard an actual or potential hazardous atmosphere? 3. If yes, will ventilation alone maintain safe conditions? If YES was marked in item 2 above, the space may use alternate entry procedures. If at any time the space changes and other hazards are present, it is automatically a permit-required confined space again. Section D. Final Determination Yes No If alternate entry procedures (section C) are not allowed and if yes was marked for any hazards in section B items 2-4, then a permit is required. 1. Non-Permit Confined Space 2. Permit-Required Confined Space 3. Alternate Entry Procedures Allowed NOTE: Careful consideration must be given to spaces that have limited radio or cellular phone coverage. Effective communication is required for all permit required confined space operations. 11

13 Appendix 3 General Confined Space Entry Guidelines A. Pre-Entry Guidelines i. Notify the Department of Safety and Security (formerly Northwestern University Police) prior to entry into a Permit-Required Confined Space. This information should be noted on the entry permit. Evanston Campus: (847) Chicago Campus: (312) ii. Confined spaces may be immediately dangerous to life or health (IDLH); iii. Conduct a confined space assessment to evaluate work activities that will reclassify a confined spaced as a permit-required confined space; refer to Appendix 1 for instruction and Appendix 2 for an example of the form; iv. Conduct pre-work briefings describing work conditions, hazards, responsibilities, assigned duties, communication, and rescue/emergency services procedures; v. Test all air monitoring equipment before each entry into a confined space in accordance with the manufacturer s instructions; calibrate if necessary; vi. Retain and record all air monitoring test/calibration data with the entry permit; vii. Entry Supervisor will assure air monitoring has been conducted within 15 minutes prior to entering any permit-required confined space; viii. Atmospheric testing must check for oxygen levels (must be between 19.5 and 23.5), explosive gas levels (must be lower than 10 of the lower explosive limit), carbon monoxide (must be less than 35 ) and hydrogen sulfide (must be less than 10 ) in that order; ix. No employee may enter a confined space until all identified hazards are eliminated or controlled, and acceptable entry conditions have been established; x. If the minimum oxygen content of 19.5 percent cannot be maintained by forced air ventilation, and the environment is oxygen deficient, consult with Facilities Management Operations and ; xi. When continuous forced air ventilation is used to eliminate a hazardous atmosphere, air should be taken from a clean source and should be continued until all employees have left the space. This method shall not be used if asbestos is present in the space; xii. Complete and post the authorized confined space permit at the entry portal, or by any other equally effective, conspicuous manner prior to beginning work. B. Entry Guidelines i. Only trained and authorized employees may enter a confined space or act as an attendant; measures shall be in place to prevent unauthorized entries; ii. During permit-required confined space entries, an attendant must be present at all times; the attendant shall not perform any other tasks that could potentially interfere with his/her abilities to provide any/all support necessary to the entrant(s); iii. Smoking is prohibited in confined spaces and near the entrance/exit area. Keep running vehicles away from the permit workspace; 12

14 iv. Maintain constant visual or voice communication between the attendant and entrants entering a permit-required confined space using intrinsically safe communications; v. Access spaces with engulfment hazards away from affected areas or by top entry only; vi. Communicate all air monitoring results to all entrants or their authorized representative; vii. Protect all openings to confined spaces with barriers when hatches, covers, or lids are removed to protect entrants and others from potential hazards; viii. When the possibility of a release of hazardous energy exists, the appropriate lockout/tag out procedures shall be utilized; ix. Utilize all required personal protective equipment; x. In the event a hazardous atmosphere or condition is detected or suspected at any time during a confined space entry, all personnel shall exit the space immediately and measures shall be implemented to protect employees from the hazards before any subsequent entries take place; department supervisors should be notified; xi. If an emergency rescue becomes necessary, the Entry Supervisor or Attendant shall notify emergency services immediately and provide information, guidance and assistance as necessary to emergency services. Northwestern employees are not permitted to enter a confined space to perform a rescue under any circumstances. C. Post Entry i. Upon completion of work and all personnel have exited the confined space, the Entry Supervisor will ensure that the worksite has been returned to safe conditions and will close out the permit. ii. The Department of Safety and Security should be notified upon completion of the confined space entries. 13

15 Appendix 4 Permits to be posted at the point of entry or by any other equally effective, conspicuous manner. Confined Space Entry Permit CONFINED SPACE ENTRY PERMIT Permits are valid for no more than 1 shift (8 hours) Space to be Entered: Location of Space: Purpose of Entry: ENTRANT(S): ATTENDANT(S): General Date & Time Issued: Date & Time of Expiration: Department or Contractor: Requirements Assessment Reviewed: Actual or Potential Hazards: None Atmos Entrap Engulf/Suff Other (Specify) Special Requirements Y N/A Special Equipment Y N/A Secure Area or Work Zone (Barricading, Fencing-Off) Fire Extinguisher (not CO2) Pumps / Lines Blanked, Blocked, Capped Purging, Flushing, Venting of Utility Lines Other Permits (eg: Hot Work): (Specify) Special Lighting (eg: Explosion Proof) Portable Blower (for Forced-Air Ventilation) Water Pumps Other Special Requirements: (Specify) Other Equipment: (Specify) Energy Sources Isolated: Elect Mech Hydr Pneum Chem Therm Steam Other (Specify) Entrant Communication: Radio Cellular Phone Visual Verbal Fixed Telephone Other (Specify) Required Personal Protective Gloves Safety Glasses Goggles Hardhat Ear Plugs / Ear Muffs Safety Shoes / Boots Equipment: Body Protection Face Shield Respirator Other (Specify) Atmospheric Testing Pre-Entry Time Time During Entry - Record Readings Every 2 Hours (8 Hour Maximum) Atmospheric Gases Permissible Limits AM AM AM AM AM AM (test in this order) (Must be within limits) PM PM PM PM PM PM Oxygen (O2) 19.5 to 23.5 LEL (Lower Explosive Limit) Under 10 Carbon Monoxide (CO) Under 35 Hydrogen Sulfide (H2S) Under 10 Other: (Specify) (Specify) Tester's Initials: Monitoring Equipment Make and Model Serial Number Calibration Date Bump Test Y Passed Prior to Use? (Required) Rescue Rescue Method Y N/A Attendant Requirement Y N/A Non-Entry Retrieval Equipment (Tripod, Lifeline, Harness) Trained in the Use of Non-Entry Equipment Rescue Service On-Site (SCBA's, Entry Retrieval Equipment) Has Means to Summon Rescue Services (Required) Rescue Communication: Radio Cellular Phone Visual Verbal Fixed Telephone Other (Specify) Northwestern Police Notified Prior to Entry: Evanston Campus (847) Chicago Campus (312) I have reviewed the work authorized by this permit and the information contained here-in. This permit is not valid unless all appropriate items are completed. I certify that all actions and conditions necessary for safe entry have been performed. Chief or Supervisor Authorizing Entry (PRINT): Authorization (SIGN): Cancellation Entry will be terminated and the Confined Space Entry Permit will be cancelled when: 1) The entry operations covered by the permit have been completed; or 2) A condition that is not allowed under the entry permit arises in or near the permit space; Re-entry into the confined space will not be allowed until a new assessment is completed and permit is issued. Permit must be cancelled by Entry Supervisor and kept on file by departments for 3 years. Permit Cancelled by: Date & Time: Reason: Work Complete Rescue Unavailable Conditions Violate Permit New Hazards Other (Specify) 14

16 Appendix 5 Use this form to temporarily classify a permit-required confined space as a nonpermit required confined space. Post form at entry site. Confined Space Reclassification Form CONFINED SPACE RECLASSIFICATION FORM Not for use at the Evanston Utility Plant, Chicago Heating Plant, and Evanston Lift Stations This form is only valid for the duration of work being performed and for no more than 8 hours Space to be Entered: Location of Space: Purpose of Entry: ENTRANT(S): ATTENDANT(S): General Date & Time Issued: Date & Time of Expiration: Department or Contractor: Requirements Confined Space Assessment Criteria for Reclassification YES NO Has the confined space hazard assessment form been reviewed? Has the atmosphere been tested at all levels within the space and are results within permissible limits? (Record pre-entry results below and retest at least every two hours) Have all potential or actual atmospheric hazards been eliminated? Have all serious hazards within the space been eliminated without entry into the space? (Entrapment, engulfment, exposed steam, exposed electrical, extreme temperatures, mechanical, etc) Will work being done inside or near the space not introduce new serious hazards? (Welding, chemicals, exposed steam, exposed electrical, painting fumes, etc) Will continuous forced-air ventilation be in use for the duration of work being performed inside the space? Will an attendant be outside the space any time work is being performed inside the space? (Attendant must have means to communicate with entrant and have the ability to summon rescue services, eg: 911, UHF Radio) Atmospheric Gases (test in this order) Permissible Limits (Must be within limits) Atmospheric Testing Pre-Entry Time Time During Entry - Record Readings Every 2 Hours (8 Hour Maximum) AM AM AM AM AM AM PM PM PM PM PM PM Oxygen (O2) 19.5 to 23.5 LEL (Lower Explosive Limit) Under 10 Carbon Monoxide (CO) Under 35 Hydrogen Sulfide (H2S) Under 10 Other: (Specify) (Specify) Tester's Initials: Monitoring Equipment Make and Model Serial Number Calibration Date Bump Test Passed Prior to Use? (Required) Y Final Determination If all conditions are checked 'YES' in the requirements section, employees may temporarily enter the confined space without a permit Conditions Safe for Temporary Entry Without a Permit Conditions Unsafe for Temporary Entry Without a Permit Authorization I have reviewed the work authorized by this form and the information contained here-in. This form is not valid unless all appropriate items are completed. I certify that all actions and conditions necessary for safe entry have been performed. Chief or Supervisor Authorizing Entry: (PRINT): (SIGN): Cancellation Entry will be terminated and this form will be cancelled when: 1) The entry operations covered by this form have been completed; or 2) A condition that is not allowed under this form arises in or near the space; Re-entry into the confined space will not be allowed until all hazards are controlled or eliminated and a new reclassification form or permit is completed. Form must cancelled by Entry Supervisor and kept on file by departments for 3 years. Cancelled by: Date & Time: Reason: Work Complete Conditions Violate Form New Hazards Other (Specify) 15

17 Appendix 6 Use this form to temporarily enter a permit-required confined space using Alternate Entry Procedures (no permit required). Post form at entry site Confined Space Alternate Entry Form CONFINED SPACE ALTERNATE ENTRY FORM This form is only valid for the duration of work being performed and for no more than 8 hours Space to be Entered: Location of Space: Purpose of Entry: ENTRANT(S): ATTENDANT(S): General Date & Time Issued: Date & Time of Expiration: Department or Contractor: Requirements Confined Space Assessment Criteria for Alternate Entry Procedures YES NO Has the space hazard assessment form been reviewed? Is the only hazard in the space an actual or potential hazardous atmosphere? (Specify): Have all serious hazards within the space been elminated without entry into the space? (Entrapment, engulfment, exposed steam, exposed electrical, extreme temperatures, mechanical, etc) Will continuous forced-air ventialtion alone be sufficient to maintain the space safe for entry? (Record pre-entry results below and re-test at least every two hours) Will continuous forced-air ventilation be in use for the duration of work being performed inside the space? Will work being done inside or near the space not introduce new serious hazards? (Welding, chemicals, exposed steam, exposed electrical, painting fumes, etc) Will an attendant be outside the space any time work is being performed inside the space? (Attendant must have means to communicate with entrant and have the ability to summon rescue services, eg: 911, UHF Radio) Atmospheric Gases (test in this order) Monitoring Equipment Make and Model Permissible Limits (Must be within limits) Tester's Initials: Atmospheric Testing Pre-Entry Time Time During Entry - Record Readings Every 2 Hours (8 Hour Maximum) AM AM AM AM AM AM PM PM PM PM PM PM Oxygen (O2) 19.5 to 23.5 LEL (Lower Explosive Limit) Under 10 Carbon Monoxide (CO) Under 35 Hydrogen Sulfide (H2S) Under 10 Other: (Specify) (Specify) Serial Number Calibration Date Bump Test Passed Prior to Use? (Required) Y Final Determination If all conditions are checked 'YES' in the requirements section, employees may temporarily enter the confined space without a permit Conditions Safe for Temporary Entry Without a Permit Conditions Unsafe for Temporary Entry Without a Permit We have reviewed the work authorized by this form and the information contained here-in. This form is not valid unless all appropriate items are completed. We certify that all actions and conditions necessary for safe entry have been performed. Risk Management Representative: (PRINT): (SIGN): Chief or Supervisor Authorizing Entry: (PRINT): Authorization (SIGN): Cancellation Entry will be terminated and this form will be cancelled when: 1) The entry operations covered by this form have been completed; or 2) A condition that is not allowed under this form arises in or near the space; Re-entry into the confined space will not be allowed until all hazards are controlled or eliminated and a new alternate entry form or permit is completed. Form must cancelled by Entry Supervisor and kept on file by departments for 3 years. Cancelled by: Date & Time: Reason: Work Complete Conditions Violate Form New Hazards Other (Specify) 16

18 Appendix 7 Bump Test Log Sheet Bump Test Log Sheet Date Monitors Type Serial Number H2S CO O2 LEL Testers Name 17