Title Page
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Site conducted
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Conducted on (Date and Time)
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Prepared by
Untitled Page
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Did your survey of the surrounding area show it to be free of hazards such as drifting vapors from tanks,piping or sewers?
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Does your knowledge of industrial or other discharges indicate this area is likely to remain free of dangerous air contaminates while occupied?
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Are you competent in the operation of the gas monitor to be used?
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Has a gas monitor functional test (bump test) been performed this shift on the gas monitor to be used?
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Did you test the atmosphere of the confined space prior to entry?
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Did the atmosphere check as acceptable ( no alarms given) ?
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Will the atmosphere be continuously monitored while the space is occupied?
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Have the proper control measures (mechanical ventilation) been installed to eliminate a potentially hazardous atmosphere?
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Have the applicable SDS sheets for products being used been reviewed by all who are to be occupying the space?