Confined Spaces Plan And Rescue Arrangements

• Have you completed Low Risk Confined spaces Training Level 2?

  Yes

  No

• STOP.
  
  YOU ARE NOT AUTHORIZED TO PERFORM THIS WORK. SEEK GUIDANCE FROM YOUR SRMET OR RMEAM

  

• Please upload a picture of your in-date training record or card

  Media

• Site conducted

  Select

• Job title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Closest hospital location to EMA2

Work and location information:

• Job title

• Equipment

• SCADA location

• WO number

Entrant information

Entrant

• Name

• login

• Date

  Date

• Rescue plan completed by:

  Sign

• Supervisor Name & Signature (L4+)

  Sign

Pre entry requirements

• 1. All RME carrying out task to perform radio check to confirm clear communication before anyone enters the space
  
  2. LOTO to be applied to in-feed and out-feed of Intralox, also the Intralox itself and the manual induct that correlates to the chute being used as part of the rescue plan. (The chute will be listed below)
  
  3. Verification of LOTO and zero energy state is mandatory prior to work commencing.
  
  4. Evacuation chair and first aid kit to be positioned on mezzanine floor at the base of chute for recovery in the event of an evacuation from the space.
  
  5. Risk assessment and job specific V.S.O.P read and understood by all entry team members.
  
  6. O.M.R.A to be carried out prior to any works taking place
  
  7. Rescue plan to be briefed and signed by all RME team members involved in task.
  

Types of communication methods being used:

• 

• Select applicable

  Select Radio (ch 3) Visual (hand signals) Audible (talking between team)

  • Radio (ch 3)
  • Visual (hand signals)
  • Audible (talking between team)

Type of rescue plan to be implemented

• 

• Select from the list

  Select Self-rescue External rescue Entry rescue

  • Self-rescue
  • External rescue
  • Entry rescue

Rescue procedure SSOW:

• 

• The above tick list determines which steps apply to this job: confirm intent

  Self-rescue

  External rescue

  Entry rescue

Personal protective equipment required:

• 

• Select applicable

  Select Foot Protection Hand Protection High visibility Vest Eye Protection Head Protection

  • Foot Protection
  • Hand Protection
  • High visibility Vest
  • Eye Protection
  • Head Protection

Signatures of understanding:

RME tech

• RME Technician Name|Date|Sign

  Sign

• Time in:

  Date

• Time out:

  Date

End of job sign offs:

• Supervisor (L4+)

  Sign

• Rescue plan author:

  Sign