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
  • Add signature

  • Attendant

  • Person
  • Add signature

  • Communications to be Used During Entry:

  • Rescue procedures

The following conditions have been evaluated for safe entry

  • 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.

  • Select date

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

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