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Confined Space Required Entry Permit

The Confined Space Entry Permit is the most essential tool for assuring safety during entry in confined spaces with known hazards or with unknown or potentially hazardous atmospheres. The entry permit process guides the supervisor and workers through a systematic evaluation of the space to be entered.
MaintainX
07/26/2022

Confined Space Required Entry Permit

36 steps
The Confined Space Entry Permit is the most essential tool for assuring safety during entry in confined spaces with known hazards or with unknown or potentially hazardous atmospheres. The entry permit process guides the supervisor and workers through a systematic evaluation of the space to be entered.
  • Project Name:

  • Project Location

  • Number:

  • Completed By:

  • Date:

  • Location:

  • Type of Space:

  • Reason for Entry:

  • Atmospheric Hazards:

  • Physical Hazards:

  • Hazard Controls:

  • Beginning Date

  • Beginning Time: (AM/PM)

  • Ending Date

  • Ending Time: (AM/PM)

  • Authorized Personnel:

  • Entrants’ Names with Dept./Shop/Company

  • Required Equipment:

  • Communication Methods with Entrants:

  • Communication Methods to Contact Emergency Services:

  • Personal Protective Equipment:

  • Traffic Control:

  • Hot Works:

  • Atmospheric Testing: Type of Gas Monitor: Date of Last Calibration:

  • Tests

  • Oxygen (19.5-23.5%)

    • Pass
    • Flag
    • Fail
  • Combustible Gas (Below 10% LEL)

    • Pass
    • Flag
    • Fail
  • Carbon Monoxide (0-25 ppm)

    • Pass
    • Flag
    • Fail
  • Initials of Tester

  • Approvals

  • Entry Supervisor:

  • Print Name:

  • Sign:

    Click here to sign
  • I assumed the responsibility of Entry Supervisor on (DATE)/(TIME)

  • Entry Supervisor:

  • Print Name:

  • Sign:

    Click here to sign
  • This Confined Space Entry Permits has been Revoked because:

  • Entry Supervisor:

  • Print Name:

  • Sign:

    Click here to sign
  • Comments:

Source: MaintainX (Community Member)

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