Return to index New query |
ENTRY PERMIT PERMIT VALID FOR 8 HOURS ONLY. ALL COPIES OF PERMIT WILL REMAIN AT JOB SITE UNTIL JOB IS COMPLETED DATE: - - SITE LOCATION and DESCRIPTION ____________________________ PURPOSE OF ENTRY ____________________________________________________ SUPERVISOR(S) in charge of crews Type of Crew Phone # _____________________________________________________________________ _____________________________________________________________________ COMMUNICATION PROCEDURES ____________________________________________ RESCUE PROCEDURES (PHONE NUMBERS AT BOTTOM) _________________________ _____________________________________________________________________ * BOLD DENOTES MINIMUM REQUIREMENTS TO BE COMPLETED AND REVIEWED PRIOR TO ENTRY* REQUIREMENTS COMPLETED DATE TIME Lock Out/De-energize/Try-out ____ ____ Line(s) Broken-Capped-Blanked ____ ____ Purge-Flush and Vent ____ ____ Ventilation ____ ____ Secure Area (Post and Flag) ____ ____ Breathing Apparatus ____ ____ Resuscitator - Inhalator ____ ____ Standby Safety Personnel ____ ____ Full Body Harness w/"D" ring ____ ____ Emergency Escape Retrieval Equip ____ ____ Lifelines ____ ____ Fire Extinguishers ____ ____ Lighting (Explosive Proof) ____ ____ Protective Clothing ____ ____ Respirator(s) (Air Purifying) ____ ____ Burning and Welding Permit ____ ____ Note: Items that do not apply enter N/A in the blank. **RECORD CONTINUOUS MONITORING RESULTS EVERY 2 HOURS CONTINUOUS MONITORING** Permissible _____________________________ TEST(S) TO BE TAKEN Entry Level PERCENT OF OXYGEN 19.5% to 23.5% ___ ___ ___ ___ ___ ___ ___ ___ LOWER FLAMMABLE LIMIT Under 10% ___ ___ ___ ___ ___ ___ ___ ___ CARBON MONOXIDE +35 PPM ___ ___ ___ ___ ___ ___ ___ ___ Aromatic Hydrocarbon + 1 PPM * 5PPM ___ ___ ___ ___ ___ ___ ___ ___ Hydrogen Cyanide (Skin) * 4PPM ___ ___ ___ ___ ___ ___ ___ ___ Hydrogen Sulfide +10 PPM *15PPM ___ ___ ___ ___ ___ ___ ___ ___ Sulfur Dioxide + 2 PPM * 5PPM ___ ___ ___ ___ ___ ___ ___ ___ Ammonia *35PPM ___ ___ ___ ___ ___ ___ ___ ___ * Short-term exposure limit:Employee can work in the area up to 15 minutes. + 8 hr. Time Weighted Avg.:Employee can work in area 8 hrs (longer with appropriate respiratory protection). REMARKS:_____________________________________________________________ GAS TESTER NAME INSTRUMENT(S) MODEL SERIAL &/OR & CHECK # USED &/OR TYPE UNIT # ________________ _______________ ___________ ____________ ________________ _______________ ___________ ____________ SAFETY STANDBY PERSON IS REQUIRED FOR ALL CONFINED SPACE WORK SAFETY STANDBY CHECK # CONFINED CONFINED PERSON(S) SPACE CHECK # SPACE CHECK # ENTRANT(S) ENTRANT(S) ______________ ______ __________ _______ __________ ______ ______________ ______ __________ _______ __________ ______ SUPERVISOR AUTHORIZING - ALL CONDITIONS SATISFIED____________________ DEPARTMENT/PHONE ___________________________ AMBULANCE 2800 FIRE 2900 Safety 4901 Gas Coordinator 4529/5387
NOTE: Authority cited: Section 142.3, Labor Code. Reference: Section 142.3, Labor Code.
HISTORY
1. New Appendix D filed 11-24-93; operative 12-24-93 (Register 93, No. 48).
Go Back to Article 108 Table of Contents