Entry Assessment for Pits, Drywells, Dam Intake Towers and Vacuum Sewers

Entry Specifications

• Entry Assessment for

• Document No.

• Conducted on

  Date

• Assessor (Responsible Person)

• Asset Location

• Asset Identification

• Work Order Number (if applicable)

• Reason for entry

  Inspection

  Valve / equipment operation

  Other

• Enter description

• USE OF FORM

• 1. A gas test (Atmospheric Monitoring) is required prior to entry to -

• A) Dry wells on wastewater conveyance systems

• B) Water valve pits if either - it has a solid cover, or abnormal conditions are suspected that cause doubt about the safety of the atmosphere (eg. Odours, large volume of rotting organic matter)

• C) Wastewater valve pits if either - it is deeper than 1.5 metre, it has a solid cover, or abnormal conditions are suspected that cause doubt about the safety of the atmosphere

• D) Dam Intake Towers should be gas tested upon descent by the first entrant

• E) Vacuum Sewers

• 2. The form is used to record the results of gas tests, where a test is required (as above).

• A single form may be used for extended work with intermittent entries, unless conditions or the scope of work changes.

• Where suitably programmed, gas test results may be recorded on a Personal Digital Assistant (PDA) as an alternative to this form.

• The form may also be used an aid to identify the abnormal circumstances when the structure will be deemed a Confined Space. (Note: It is NOT a comprehensive risk assessment, and does not address other associated risks such as falls.).

• 3. If ALL questions are answered YES, the structure is not deemed a Confined Space. Proceed with caution and ensure that Safe Job Planning and Rescue Plan are in place.

• If ANY question is answered NO, do not proceed with the job. Contact the supervisor for a full CSE Permit. Complete a Hazard Report if an Unsafe Atmosphere was detected.

• 4. If (prior to the completion of this form) it is apparent that the circumstances will make the structure a Confined Space, use of this form may be bypassed (complete a CSE Permit instead).

• The atmosphere has been tested and found to be within Relevant Exposure Standards. (Test for chlorine where a chlorine line is located in or adjacent to the structure)

  No

  Yes

• O2 level is

• (19.5 to 23.5%)

• CH4 (LEL) is

• (<5%)

• CO level is

• (< 30 ppm)

• H2S level is

• (<10 ppm)

• Chlorine level is

• (< 0.5 ppm)

• Other

• Test conducted by (name)

• Test instrument number

• Test instrument last calibrated

  Date

• Test instrument last bump tested (if known)

  Date

• The work is free of activities that may cause an Unsafe Atmosphere

  No

  Yes

• An assessment indicates no other apparent factors that may cause an Unsafe Atmosphere

  No

  Yes

• Necessary isolation has been completed

  No

  Yes

• Pressure services are in good condition

  No

  Yes

• The work is FREE of activities that involve a risk of engulfment

  No

  Yes

• An assessment indicates no other apparent factors that may cause engulfment

  No

  Yes

• For this entry, the structure is assessed as a Confined Space (requires a CSE Permit and Rescue Plan to be in place)

• OR

• NOT a Confined Space. Safe Job Planning and a Rescue Plan to be in place (Mandatory)