Audit

Pre-Entry Atmospheric Testing
Time
Oxygen %
Allowable: 19.5% - 23.5%
LEL %
Allowable: 0 - 10%
CO (ppm)
Allowable: 0 - 35 ppm
H2S (ppm)
Allowable: 0 - 10 ppm

Test equipment used

Calibration Date
Entry Personnel and Attendants

Entry Personnel

Person
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Attendant

Person
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Communications to be Used During Entry:

Rescue procedures

The following conditions have been evaluated for safe entry

Adequate Ventilation

No Hazardous Chemicals

No Toxic Fumes, Gases, or Vapors

No Nearby Hazardous Operations

No CO from Heaters, Generators, etc.

No Mechanical Hazards

No Electrical Hazards

Adequate Lighting

No Heat or Cold Extremes

No Fire Hazards

No Engulfment Hazards

NON-PERMIT CONFINED SPACE CLASSIFICATION: For this space to be classified as Non-Permit Required Confined Space, the supervisor must sign the following statement:
I have reviewed the above work area and have determined that the space is free of any recognized hazards, which would define this space to be a permit required confined space.
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Periodic Atmospheric Testing During Entry

Enter time of testing

Time
Time
Oxygen %
Allowable: 19.5% - 23.5%
LEL %
Allowable: 0 - 10%
CO (ppm)
Allowable: 0 - 35 ppm
H2S (ppm)
Allowable: 0 - 10 ppm
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.