Books : Permit-Required Confined Space (PRCS) : Section V: Appendices

SECTION V: Appendices

APPENDIX A - CONFINED SPACE AND PERMIT-REQUIRED CONFINED SPACE RECOGNITION FORM

Part I		Yes/No
1	Is the space large enough so an employee can bodily enter and perform work?
2	Does the space have limited or restricted means for entry and exit?
3	Is the space designed for occupancy?

Note to the Employer: Refer to Section II for additional clarification and assistance. If the answers to items 1 and 2 are yes and item 3 is no, then the space is not considered a confined space and no further action is needed. If the answers to items 1,2 and 3 are yes, then you have identified the space as a confined space. Continue to Part II if a confined space has been identified to determine if it is a permit-required confined space.

Part II		Yes/No
1	Does the space contain or potentially contain a hazardous atmosphere?
2	Does the space contain any chemicals or chemical residues?
3	Does the space contain any flammable/combustible substances?
4	Does the space contain or potentially contain any decomposing organic matter?
5	Does the space have any pipes which bring chemicals into it?
6	Does the space have any materials that can trap or potentially trap, engulf or drown an entrant?
7	Is vision obscured by dust at 5 feet or less?
8	Does the space contain any mechanical equipment?
9	Does the space have converging walls, sloped floors or tapered floor to smaller cross-sections which could trap or asphyxiate an entrant?
10	Does the tank or vessel contain a rusted interior?
11	Does the space contain thermal hazards (e.g., extreme hot or cold)?
12	Does the space contain excessive noise levels which could interfere with communication with an attendant?
13	Does the space present any slip, trip or fall hazards?
14	Are there any hazards from falling objects?

APPENDIX A - CONFINED SPACE AND PERMIT-REQUIRED CONFINED SPACE RECOGNITION FORM

Part II		Yes/No
15	Are there any operations conducted near the space opening which could present a hazardto entrants?
16	Are there lines under pressure servicing the space?
17	Are cleaning solvents or paints going to be used in the space?
18	Is welding, cutting, brazing, riveting, scraping or sanding going to be performed in the space?
19	Is electrical equipment located in or required to be used in the space?
20	Does the space have poor natural ventilation which would allow an atmospheric hazard to develop?
21	Are there any conditions which could prevent any entrant's self rescue from the space?
22	Are there any corrosives which could irritate the eyes in the space?
23	Are there any substances used in the space which have acute hazards?
24	Is mechanical ventilation needed to maintain a safe environment?
25	Is air monitoring necessary to ensure the space is safe for entry due to a potential hazardous atmosphere?
26	Will entry be made into a diked area where the dike is 5 feet or more in height?
27	Are residues going to be scraped off the interior surfaces of the vessel?
28	Are non-sparking tools required to remove residues?
29	Does the space restrict mobility to the extent that it could trap an entrant?
30	Is respiratory protection required because of a hazardous atmosphere?
31	Does the space present a hazard other than those noted above which would make it a permit space?

Note to the Employer: If any of the questions in Part II have been checked Ayes@, the confined space is a permit-required confined space. As such, entry into these spaces must be performed under the protection of a full permit-required confined space program. Note that in some situations, alternative procedures or reclassifying to a non-permit space may be possible in lieu of a full permit-required confined space program.

APPENDIX B - ALTERNATIVE PROCEDURE WORK SHEET

Note to the Employer: This worksheet is intended to provide written certification that the permit space qualifies for alternative procedures and verifies that the space is safe for entry. This checklist should be augmented with any relevant information for this certification process.

1)	a) Permit Space Location b) What is the size (volume) and configuration of the space?
2)	a) Have employees received permit space training? b) Has the certifier received permit space training?	Y N Y N
3)	a) What tasks are to be performed during the entry operation? b) Is a hazardous atmosphere the only hazard of concern? If no, alternative procedures cannot be used.	Y N
4)	Does the atmospheric hazard in the space have the potential to create high temperatures or high pressures? If yes, take appropriate action before removing cover.	Y N
5)	Are conditions safe to remove cover? If no, cover removal is prohibited.	Y N
6)	After cover removal, is opening properly guarded? List guarding methods:	Y N
7)	a) Continuous forced air ventilation provided? If no, explain why : If yes, explain capacity (CFM) air exchange rate. b) Minimum ventilation duration prior to allowing entry Note: Refer to Section III for information on ventilation systems and appropriate calculations. Conduct pre-entry atmospheric testing and continue to ventilate the space during the entire entry operation.	Y N
8)	Is atmospheric testing equipment calibrated? Date of calibration:	Y N

APPENDIX B - ALTERNATIVE PROCEDURE WORKSHEET

9) Atmospheric Testing Record:

Substance	Acceptable Level	Readings
Oxygen	19.5% - 23.5%
Explosive (Gas/Vapor)	<10% LFL
Explosive Dust	<LFL (5 ft. Visibility)
Carbon Monoxide	50 PPM
Hydrogen Sulfide	10 PPM

10)	Does inspection of interior have to be conducted to see if other hazards exist? If yes, full entry program is required.	Y N
11)	a) Is frequent or periodic testing performed? If no, explain why b) Who is to perform frequent or periodic monitoring?	Y N
12)	a) If a hazardous atmosphere is detected during entry, have employees been instructed to evacuate immediately? b) Is there a procedure to reevaluate the space if a hazardous atmosphere does develop? Describe Procedure: c) Have steps been taken to prevent employees from re-entering the space until it is proven to be safe? List steps :	Y N Y N Y N
13)	Have employees had the opportunity to review the data to support use of alternative procedures?	Y N

Signature of Certifying Head Date

APPENDIX C - RECLASSIFYING PERMIT SPACE WORK SHEET

1)	Permit Space Location
2)	Have employees received permit space training?	Y N
3)	A. Are any hazardous atmospheres present or potentially present? B. Is continuous forced air ventilation needed to maintain acceptable levels? C. Is air monitoring required? If yes, record test results.	Y N Y N Y N
		Y N Y N Y N

ATMOSPHERIC TESTING RECORD

Substance	Acceptable Level	Readings
Oxygen	19.5% - 23.5%
Explosive (Gas/Vapor)	<10% LFL
Explosive Dust	<LFL (5 ft. Visibility)
Carbon Monoxide	50 PPM
Hydrogen Sulfide	10 PPM

Is atmospheric testing equipment calibrated?

Date of calibration :

Y N

Note to the Employer #1: If hazardous atmospheres are present or ventilation is needed to control levels, then reclassifying the space is not possible. It is necessary to eliminate the atmospheric hazard to reclassify (see Note to the Employer #2).

4)	Is an engulfment hazard present? If yes, what control measure is used to eliminate the engulfment hazard?	Y N
5)	Is there an entrapment hazard? If yes, then list the steps to be taken to eliminate the hazard.	Y N

APPENDIX C - RECLASSIFYING PERMIT SPACE WORK SHEET

Have all hazardous energy sources (including chemical and physical hazards) been eliminated? Y N

Check isolating methods used to eliminate the hazard(s).

deenergize equipment

locking out electrical circuits and related training provided

tagging out electrical circuits and related training provided

physically block machinery so it can not move

blank or blinds

double block and bleed

locking and/or tagging valves

disconnecting lines

other procedures, be specific:

Note to the Employer: The above listed isolation techniques are generally used in combination to ensure elimination of the hazard(s).

Is it necessary to enter the permit space to determine if the hazard has been eliminated?

If yes, then the entry must be performed in accordance with a full PRCS program, paragraphs (d) through (k).

Y N

Note to the Employer #2: Permit spaces that contain or have the potential to contain hazardous atmospheres may also be reclassified as non-permit spaces if the source of the hazardous atmosphere can be eliminated during the entire entry operation. After the space is isolated, purged and ventilated from outside, it must be entered to test the atmosphere and inspect conditions within the space in order to ensure that the hazards have been eliminated. This entry must be conducted in accordance with the full permit space program requirements given in paragraphs (d) through (k). Once again, control of a hazardous atmosphere is not the same as its elimination. This reclassification would also be valid only as long as the hazards remain eliminated.

7)	Have all employees who will enter the declassified space been instructed to immediately evacuate the space if a hazard is detected? If no, instruct employees of this safety precaution measure.	Y N
8)	Has a procedure been instituted to re-evaluate the space and reclassify it back to a permit space if the need arises? If no, then institute steps to properly re-evaluate the space, prohibit entry and if necessary reclassify it back to a permit space. If yes, describe procedure:	Y N

APPENDIX C - RECLASSIFYING PERMIT SPACE WORK SHEET

Have all employees participating in the entry operation had and opportunity to review this safe entry certification form?

Y N

Signature of Certifying Head Date

APPENDIX D - PERMIT-REQUIRED CONFINED SPACE (PRCS) PROGRAM WORK SHEET

Permit Space Location:

Hazards	Acceptable Entry Conditions

Equipment	Required Yes/No	Type
Air testing monitor
Forced air ventilation
Communication
Personal Protective Equipment
Lighting
Barriers
Entry/Egress
Rescue Equipment
Respirator
Other Equipment

Methods to prevent Unauthorized Entry:
Specific Space Entry Procedures:

APPENDIX D - PERMIT-REQUIRED CONFINED SPACE (PRCS) PROGRAM WORK SHEET

Designated Required Personnel:
Authorized
Entrant's Name(s):
Duties:
Attendant's
Name(s):
Duties:
Is one attendant monitoring multi-spaces at the same time?	Y N
If yes, 1) list method(s) to monitor multi-spaces:

2) Provide procedure(s) to respond to an emergency and still be able to ensure the safety of the other spaces:
Entry Supervisor's
Name:
Duties:
Air Monitor's Name:
Duties:

APPENDIX D - PERMIT-REQUIRED CONFINED SPACE (PRCS) PROGRAM WORK SHEET

Entry Permit: (company representative's name) will provide entry permits for PRCS operations. All entry permits will be completed by the entry supervisor authorizing entry. Upon cancellation of the entry permit by the entry supervisor, the entry permit will be returned.

Procedures for Summoning Rescue and Emergency Services:

Multi-Employer Permit Space Operation? Y N

If yes, develop procedures to coordinate entry operations.

List measures taken to close entry portal and return the space to normal operating conditions.

(Company Representative's Name) will review entry operations if measures taken did not fully protect employees [see 1910.146 (d)(13)].

(Company Representative's Name) will conduct a review of the permit program at least annually utilizing canceled entry permits. Any inadequacies will be corrected.

APPENDIX D-1 - SAMPLE COPY OF A PERMIT-REQUIRED SPACE PROGRAM WORK SHEET

Permit Space Location: Reactor Vessel #1, Production Department, Main Building

Hazards:		Acceptable Entry Conditions:
Oxygen Deficiency Flammable Substances	-Toluene -Acetone	19.5-23.5% Toluene (LEL 1.3%)<10% Cleaning Solvent (Acetone) (LEL 2.6%)<10%
Toxic Substances	-Toluene -Acetone	<150 ppm-15 min. STEL <100 ppm-8 hour PEL <1000 ppm-15 min. STEL <750 ppm-8 hour PEL
Mechanical/Engulfment-Mixer Raw Product Line Toluene	-Isolate Space -Isolate Space -Isolate Space	Lockout/Tagout/Block Disconnect Lines Purge, Clean, Ventilate

Required Equipment:

Equipment	Required Yes/No	Type
Air testing monitor	Yes	O₂ and combustible gas meter; detector tubes for toluene and acetone
Forced air ventilation	Yes	Explosion-proof fan; adequate length of hose for ventilation
Communication	Yes	Radios
Personal Protective Equipment	Yes	Splash-proof goggles, Viton gloves, chemical-resistant clothing
Lighting
Barriers
Entry/Egress
Rescue Equipment	Yes	Retrieval system (full body harness, tripod, winch) Self-contained breathing apparatus
Respirator	Yes	Air-purifying respirator with organic vapor cartridges
Other Equipment	Yes	High-pressure steam cleaner
	Yes	Isolation equipment (locks, tags)

APPENDIX D-1 - SAMPLE COPY OF A PERMIT-REQUIRED SPACE PROGRAM WORK SHEET

Specific Space Entry Procedures:

1)Have entry supervisor obtain and complete entry permit items as necessary. Refer to this written entry program for procedures to follow. Have entry supervisor contact on site rescue service to notify them of confined space entry operation in progress.

2)Isolation Procedures-

(a) Raw Product Line - Have employees wear chemical protective clothing, gloves, splash-proof goggles, air-purifying respirators with organic vapor cartridges. Close, lock and tag upstream/downstream valves to the vessel. Bleed raw product residue from between valve. Misalign or remove section of pipe and cap. Use calibrated air-monitoring equipment to test valve or cap for any leaks.

(b) Mixer - Lockout/Tagout mixer's electrical source at the control box number one, switch number two. Verify that all stored energy has been dissipated from the mixer and it is disengaged by attempting to activate mixer.

(c) Drain residual material from vessel.

3)Rinse space with acetone-containing solvent applied from grounded and bonded low-pressure steam cleaner then allow material to drain from the vessel. Make sure affluent line is open.

4)Allow vessel to cool, then rinse vessel with grounded and bonded high-pressure steam cleaner using soap and water solution. Allow material to drain from the vessel and allow it to cool.

5)Make sure it is safe to remove entrance cover, and use only spark-proof tools.

6)Have attendant conduct air monitoring using calibrated equipment. Test vessel after opening for:

a. Oxygen

b. LFL

c. Toluene

d. Acetone

7) Purge vessel with forced air ventilation for 30 minutes.

8)Retest atmospheric conditions. If hazardous atmosphere exists, repeat cleaning and purging procedures.

9)Perform continuous forced air ventilation for duration of entry operation

10)Check and set up equipment. Have authorized entrant wear personal protective equipment and full-body harness with retrieval line attached.

11)Have entry supervisor inspect operation and provide authorization for entry. Post completed and signed entry permit near entrance for employees to review.

12)Conduct additional pre-entry test and have attendant conduct continuous monitoring for duration of entry operation.

APPENDIX D-1 - SAMPLE COPY OF A PERMIT-REQUIRED SPACE PROGRAM WORK SHEET

13)Complete work inside the vessel and ensure all authorized entrants have exited from the space.

14)Notify entry supervisor for cancellation of the entry permit.

15)Return space to normal operation.

16)Return canceled permit to Safety Manager.

Designated Required Personnel:

Authorized Entrant's Name(s): Individual's Name

Duties: Know hazards, use equipment properly, communicate with attendant, and alert attendant of any hazards, exit quickly if ordered to do so.

Attendant's Name(s):

Duties: Know hazards of space, behavioral effects of hazards, keep track of number of entrants, remain outside of space during entry, communicate with entrants, monitor activities outside space, summon rescue and emergency medical services, take actions to keep unauthorized entrants away from space, perform non-entry rescues, and do no other duties while monitoring entrants.

Entry Supervisor's Name:

Duties: Know hazards of the space, verify that acceptable entry conditions exist, terminate entry operations, verify that rescue service is available, remove unauthorized persons from area and ensure acceptable entry conditions are maintained at appropriate intervals.

Air Monitor's Name:

Duties: Know hazards of the space, know acceptable entry conditions, know how to properly calibrate, use, maintain and understand limitations of the air sampling device, know how to properly interpret the results obtained from the device.

Entry Permit: (company representatives name) will provide entry permits for PRCS operations. All entry permits will be completed by the entry supervisor authorizing entry. Upon cancellation of the entry permit by the entry supervisor, the entry permit will be returned.

Procedures for Summoning Rescue and Emergency Services:

Rescue services will be onsite for the duration of the entry operation. Attendant will use walkie-talkie radio to contact security officer, who will contact onsite emergency services at .

Multi-Employer Permit Space Operation? Y N

APPENDIX D-1 - SAMPLE COPY OF A PERMIT-REQUIRED SPACE PROGRAM WORK SHEET

List measures taken to close entry portal and return the space to normal operating conditions.

Attendant will ensure all entrants have vacated the space by checking their names off the entry permit. The entry supervisor will verify that the entry operation is complete and terminate the entry permit. The entry supervisor will also check to ensure that the entry portal is replaced properly and that the vessel is returned to normal operating conditions. The entry supervisor will notify the onsite rescue services that the confined space entry operation has been completed

The safety manager will review entry operations if measures taken did not fully protect employees. The safety manager will conduct a review of the permit space at least annually utilizing canceled entry permits. Any inadequacies will be corrected.

Note to the Employer: This sample copy of a completed PRCS worksheet is intended to give employers an idea of what types of information is helpful in completing this form. The procedures outlined are merely examples and should not be expected to be the correct protocol for each permit space entry operation. The employer is reminded that the information provided in their program should be as specific as possible to be beneficial to entry team members. For example, more specific list of duties for PRCS team members is likely needed to be appropriate.

APPENDIX E - HOST EMPLOYER=S RESPONSIBILITIES WITH CONTRACTOR WORK SHEET

In accordance with the requirements of the OSHA Permit-Required Confined Space Standard 1910.146, this information is being made available to (Name of Contracting Company) so they can take appropriate precautions to protect their employees during a PRCS operation. The following is a list of permit space locations, their identified hazards and any precautions taken by our firm.

Location	Hazard	Precautions Taken

Other applicable information concerning the permit space which may be of assistance:

Note to the Employer: A PRCS program is required for these spaces, unless alternative procedures or reclassification procedures can be utilized and certified to allow safe entry.

During the contractor's PRCS operation, our employees (will) (will not) be involved in entry or work near the permit space.

If our employees will be involved with entry into or near the permit space, then (Host Employer Representative's Name) will coordinate the entry operations with the contractor.

List whose permit space program will be used for entry into the space: (Host Employer's) OR (Contractor's)

APPENDIX E - HOST EMPLOYER'S RESPONSIBILITIES WITH CONTRACTOR WORK SHEET

Note to the Employer: This coordination should include a determination of whose permit program is to be used. The standard does not prohibit the host employer from requiring a contractor to use the host employer's permit program, nor does it require the contractor to use the host's program. The employer may choose to condition its contract on the contractor's compliance with the host's program.

Debriefing conference will be held with, (Host Employers representative) and (Contractors Representative) at the completion of the entry operation. At a minimum, the following items must be covered:

Was the PRCS program adequate?	Y N
If no, what deficiencies were noted?
Were there any hazards confronted or created by the entry operation (e.g.; hazardous atmosphere, ventilation or testing equipment failure, unauthorized entry, etc.)?	Y N
If yes, list circumstances and actions to be taken to prevent reoccurrence.

APPENDIX F- CONTRACTOR'S RESPONSIBILITIES WITH HOST EMPLOYERS - WORK SHEET

In accordance with the OSHA PRCS Standard (1910.146), (Name of Contracting Company) is requesting that the host employer (Name of Host Employer) provide any available PRCS hazard information for the space to be entered. Additionally, please notify (Name of Contractor's Representative) if you plan to have your employees work in or near the PRCS during our entry operation.

(Name of Contractor's Representative) will inform you, the host employer, of the PRCS program our employees will follow during the PRCS operation. Additionally, (Name of Contractor's Representative) will notify you of any hazards confronted or created during our PRCS operation.

The following is a list of hazard(s) confronted by the PRCS operation and the action(s) taken to correct the condition.

Condition

Corrective Action Taken

Note to the Contractor: List any hazards confronted by your employees during the PRCS operation. Conditions to be considered include a hazardous atmosphere, ventilation or testing equipment failure, unauthorized entry, etc.

APPENDIX G - HOT WORK PERMIT

Permit No. Permit Space No.
Permit Valid For (date) (time) AM/PM , (date) (time) AM/PM
Location of Space
1) Hot Work to be performed:	grinding electrical spark-producing equipment cutting heating welding brazing or soldering space heater (Note: space heaters must not be taken into spaces. Fresh warm air should be blown in when needed) other sources of ignition

2) Specify nature of work to be performed:
3) Pre-entry atmospheric testing: Y N

Note: Frequent or continuous monitoring is required. Use entry permit to record results.

4) Flammable/combustible gas or liquid present?	Y N
Flammable/ combustible residue present?	Y N
Combustible dust present?	Y N

Note: If any item in Number 4 is marked Ayes@, then appropriate steps must be taken to ensure no flammable or explosive hazards exist. Refer to the entry permit to record the control methods needed.

5)Is ventilation provided?	General Mechanical Localized Exhaust
Is the ventilation equipment intrinsically safe?	Y N
6)Has the space been isolated?	Y N

Note: Refer to entry permit for specific entry procedures required to be in place.

7) Is fire-fighting equipment available?	Y N
Type of Equipment	Located Inside Space Located Outside Space

APPENDIX G - HOT WORK PERMIT

Have employees received training on how to use equipment?	Y N
Have authorized entrants, attendants and entry supervisors been given training on the potential hazards associated with performing these "hot work" duties?	Y N
8)If welding in a confined space, ensure the following: a) Have welding electrodes been removed from holders during suspension of welding?	Y N
b) Have welders been instructed to never allow gas cylinders or welding machines into the space and are they complying?	Y N
c) Portable equipment secured?	Y N
d) Emergency procedures in place (e.g., lifelines, rescue procedures, etc.)	Y N
e) Torch removed from space during suspension of welding?	Y N

An evaluation of the permit space operation has been conducted with respect to performing "hot work" activities. Conditions are acceptable for the "hot work" to be conducted. _____________________________________________ (signature of certifying individual) (date) (time)

APPENDIX H - Common Combustible Substances

Material	LEL (%/Vol)	UEL (%/Vol)	PEL (ppm)	IDLH (ppm)	Density (Air=1)
Acetone	2.6	12.8	1,000	20,000	2.0
Acetylene	2.5	100.0	-A-	-A-	.9
Ammonia	16.0	25.0	50	500	0.6
Benzene	1.3	7.1	1.0	-C-	2.6
N-Butyl Acetate	1.7	7.6	150	10,000	4.0
Cyclohexene	1.0	5.0	300	10,000	2.7
Ethane	3.0	12.5	-A-	-A-	1.0
Ethanol	3.3	19.0	1,000	-U-	1.6
Ethyl Acetate	2.0	11.5	400	10,000	2.6
Ethyl Ether	1.9	36.0	400	19,000	2.6
Ethylene Oxide	3.6	100.0	1	-C-	1.5
Gasoline (100 octane)	1.4	7.4	300*	-U-	3-4.0
Heptane	1.6	6.7	500	5,000	3.5
Hexane	1.1	7.5	500	5,000	3.0
Hydrogen	4.0	75.0	-A-	-A-	0.1
Isoproply Alcohol	2.0	12.0	400	12,000	2.1
Methane	5.0	15.0	-A-	-A-	0.6
Methanol	6.7	36.0	200	25,000	1.1
Methyl Ethyl Ketone (MEK)	1.8	10.0	200	3,000	2.5
Pentane	1.5	7.8	1000	15,000	2.5
Propane	2.2	9.5	1000	20,000	1.6
Styrene	1.1	6.1	100	5,000	3.6

APPENDIX H - Common Combustible Substances

Material	LEL (%/Vol)	UEL (%/Vol)	PEL (ppm)	IDLH (ppm)	Density (Air=1)
Toluene	1.2	7.1	200	2,000	3.1
Turpentine	0.8	100.0	100	1,900	4.7
Vinyl Chloride	3.6	33.0	5	-C-	2.2
Xylene	1.1	7.0	100	1,000	3.7

LEL = Lower Explosive Limit UEL = Upper Explosive Limit PPM = Parts Per Million PEL = Permissible Exposure Limit (OSHA) IDLH = Immediately Dangerous to Life & Health Data from NIOSH Pocket Guide to Chemical Hazards (1990)	Density <1.0 = lighter than air; >1,0 = heavier than air -A- = Asphyxiant -C- = Carcinogen -U- = Data not Available *ACGIH TLV

APPENDIX I - RESPIRATORY PROTECTION PROGRAM

Purpose

The elements described in this program are designed to ensure the safe and effective usage of respiratory protection at (company name) .

Program Administration

(Company Representative's Name) is responsible for the overall implementation and maintenance of the respiratory protection program.
(Company Representative's Name) duties include:

Determining which tasks require respiratory protection.

Selecting the proper respirator for the specific application.

Conducting employee training and conducting fit testing.

Ensuring employees clean, maintain and properly store respirators.

Overseeing the medical screening program for respirator users.

Conducting periodic evaluation of the respiratory program to ensure that it is achieving its desired goal.

Supervisors are responsible for:

Ensuring that the appropriate respirators are available for use.

Ensuring that employees wear the required respirators.

Conducting periodic inspections to ensure employees are adequately maintaining their respirators.

Employees are responsible for:

Using the respiratory protection in accordance with the training received.

Inspecting, cleaning, sanitizing and proper storage of their respirator.

Respiratory Selection

Our respiratory protection coordinator is responsible for selecting the appropriate respiratory protection. Selection will be made according to "Practices for Respiratory Protection" American National Standards Institute (ANSI) Z88.2-1980

The respiratory protection coordinator will select the appropriate respirators based upon the following elements:

The type of airborne contaminant(s).

The characteristics and location of the hazardous area.

The worker's activities in the hazardous area.

The capabilities and limitations of the respirators.

Duration of respirator use.

Only respirators having NIOSH/MSHA approval will be used.

Additional information for the proper selection of respiratory protection can be found in Section II - Respiratory Protection

APPENDIX I - RESPIRATORY PROTECTION PROGRAM

Respirators currently approved for use are:

Respirator Manufacturer	Model	Work Task

Determination for respiratory protection

The permit-required confined space program and the entry permit will be used to determine if respiratory protection is required for the permit-space entry operation. If engineering controls cannot control the hazard or if the airborne contaminant cannot be eliminated and entry must be conducted, respiratory protection is required.

Maintenance, Cleaning, Inspection and Storage

The entry supervisor will ensure that employees properly clean and maintain their respiratory protection.

Cleaning and sanitizing.

Disassemble components from the respirator and inspect for any defects.

Immerse the respirator and components into warm water (120-130 degrees F). Note, air-purifying filters and cartridges must never be washed. The respirator facepiece and components should be gently scrubbed to remove all dirt. Care must be taken not to damage any of the components.

Rinse the respirator and components.

Sanitize the respirators and components by immersing them into a chlorine bleach solution (approximately one ounce to one quart of water).

Rinse components and allow to dry.

Inspect, test, and repair if necessary.

Inspection should be performed before and after each use for the following:

Deterioration of any rubber or silicone parts.

Conditions of components.

Tightness of all connections.

Check any end of service life indicators.

SCBA alarms, regulators, gauges, etc.

SCBA cylinder pressure.

APPENDIX I - RESPIRATORY PROTECTION PROGRAM

Respirator Inspection Record

Respirator type model #

Components	Acceptable	Not Acceptable
Facepiece
Inhalation Valve
Exhalation Valve Assembly
Headbands
Cartridge Holder
Filter
Harness Assembly
Hose Assembly
Speaking Diaphragm
Gaskets
Connections

Note to the Employer: If any components are found not acceptable, the respirator should not be used and a replacement part or replacement respirator should be obtained.

Storage

All respirators must be properly stored to protect them from damage due to environmental factors and chemicals. When respirators are not in use, they must be placed in a plastic bag and stored in a clean area. Respirators should be stored with the facepiece and exhalation valve in a normal position to prevent it from taking a permanent distorted shape. Respirators should not be stored in work benches, tool boxes, or lockers unless they are protected against airborne contaminants, distortions and any damage.

APPENDIX I - RESPIRATORY PROTECTION PROGRAM

Note to the Employer: Ensure that management personnel periodically check to see if respirator wearers are inspecting, cleaning, maintaining and storing their equipment properly.

Training

All employees who are required to use respiratory protection will be instructed on the proper selection, use and limitations of this equipment. This training will be provided prior to any assignment requiring the use of such equipment. The training, conducted by (name) , will also include information on:

Nature of the respiratory hazard and what may happen if the respirator is not used properly.

Engineering and administrative controls being used and the need for the respirator as added protection.

Reason for selection of a particular type of respirator.

Limitations of the selected respirator.

Methods of donning the respirator and checking its fit (negative and positive checks) and operation.

Proper wear of the respirator.

Respirator maintenance and storage.

Proper method for handling emergency situations.

A record of employee names and dates and type of initial training and subsequent refresher training will be recorded.

Training Record

Name	Type of Respirator	Date

Fit Testing

No one respirator will fit every individual. Therefore, to provide the appropriate respirator, fit testing will be performed to ensure a tight seal between the facepiece and wearer.

APPENDIX I - RESPIRATORY PROTECTION PROGRAM

Respiratory Fit Test Record

a) Employee Date Employee job title

b) Respirator Selected

Manufacturer

NIOSH Approval #:

Model

c) Conditions Which Could Affect Respirator Fit: (check all that apply)

Clean Shaven Facial Scar Beard Growth

Dentures Absent Moustache Glasses None

Comments:

d) Fit Testing (check all methods used)

Qualitative Fit Testing

Isoamyl Acetate Pass Fail

Irritant Smoke Pass Fail

Saccharin Test Pass Fail

Quantitative Fit Testing Pass Fail

Comments:

Test Conducted By: Date:

Medical Examination

Individuals assigned to tasks that require the use of respiratory protection will have a medical examination to determine if they are able to perform the work while wearing a respirator. The medical examinations will be performed by (name of clinic, or physician) . The examination will be given prior to an employee being allowed to wear a respirator. Periodic examinations will be conducted .

Note to the Employer: Generally medical examinations are given annually. However, the frequency of the examinations will depend upon the age, health condition and hazards associated with the work operations. The local physician would be the best source to determine the examination frequency for a particular individual. The physician should also be informed of the nature of the hazards to be confronted by the respirator wearer. For example, the physician should be aware that the individual may use an SCBA in a confined space.

APPENDIX J - SAMPLE LETTER FROM RESCUE AND EMERGENCY SERVICE PROVIDER TO

HOST EMPLOYER - - Non-Mandatory

Dear :

This is to confirm that (rescue organization) can provide the following rescue and emergency services in the event it is needed during confined space entries at your facility. Our organization can provide the following services:

In order for us to properly develop a rescue plan, we must be informed of the hazards associated with the space and we must have access to these spaces. Please provide for us a list of your permit-required confined spaces, their locations and the hazards. I have enclosed a form you may use. In addition, we must conduct annual practice rescue entries in your confined space(s) or in some other similarly configured space(s). We would like to know if and when this could be arranged in your workplace.

Please contact (rescue organization representative) at (phone number): so that we can discuss this in more detail and make arrangements to visit your workplace before any confined space entry operations are scheduled. Thank you for your cooperation.

Sincerely,

____________________________

(rescue organization's representative)

APPENDIX J - SAMPLE LETTER FROM RESCUE AND EMERGENCY SERVICE PROVIDER TO HOST EMPLOYER - - Non-Mandatory

CONFINED SPACE LOCATIONS

__________________________

(name & location of facility)

The following is a list of permit-required confined spaces located at our facility:

Space	Location	Hazards

Prepared By:

Date:

Phone Number:

APPENDIX K - SAMPLE LETTER FROM EMPLOYER TO OUTSIDE RESCUE SERVICE

- - Non-Mandatory

Dear _________________________________:

We are currently developing a permit-required confined space program as required under the Federal OSHA regulation, 29 CFR 1910.146, that will allow our employees to safely enter and work in permit-required confined spaces in our workplace. Although our existing program is intended to prevent employee exposure to health hazards in the space, extra ordinary circumstances could appear without warning that would cause an emergency situation where the employee(s) in the space may need rescue and/or emergency medical assistance. Therefore, a very important element of our program is to develop and implement procedures for summoning rescue and emergency services. We are requesting that you be available to provide rescue and emergency services, in the event of an emergency.

Enclosed is a listing of the permit-required confined spaces in my workplace, as well as a description of the hazard(s) associated with the space(s). I am providing this information to you so that you can adequately develop a rescue plan appropriate for the space(s). You may also have access to this space as a part of your planning.

We will be contacting you shortly to confirm your willingness to participate in our permit-required confined space program and to discuss adequate notification procedures (e.g., communication contact methods at the time of scheduling the entry operation) for a timely response. At that time, we can also discuss the rescue plan provisions in more detail and offer you our assistance in working together to safeguard both your employees as well as ours.

Sincerely,

____________________________

(rescue organization's representative)

APPENDIX K - SAMPLE LETTER FROM EMPLOYER TO OUTSIDE RESCUE SERVICE

- -Non-Mandatory

CONFINED SPACE LOCATIONS

__________________________

(name & location of facility)

The following is a list of permit-required confined spaces located at our facility:

Space	Location	Hazards

Prepared By:

Date:

Phone Number:

APPENDIX L - RESCUE AND EMERGENCY SERVICES

Confined space rescues are extremely dangerous operations which must only be performed by properly trained and equipped individuals. It has been well documented that the majority of fatalities that occur in confined spaces are would-be rescuers who have not been properly trained or equipped. For rescue operations to be conducted safely, there must be a systematic approach by the rescue service. In response, the OSHA permit-required confined space standard (1910.146) mandates requirements that must be addressed for all on site and off-site rescue personnel who will enter PRCS to perform rescue or retrieval operations.

As previously mentioned, fire departments and other rescue service organizations are not required to have a full PRCS program in place for performing rescue operations. However, the performance-oriented elements stated in paragraph (g) and (k) of the standard are required so rescuers can prepare themselves for emergency PRCS operations. Paragraph (k) also requires rescue service organizations to develop a rescue plan for each PRCS they must enter.

This appendix is provided as a guide that uses a systematic approach covering the general topics and procedures rescuers may need to know or need to consider when developing rescue plans.

The standard states that when a host employer arranges to have another employer perform rescue services, the host employer must perform, the following:

Inform the rescue service of the hazard of the PRCS.

Provide access to the space so the rescue organization can develop a rescue plan and practice rescue operations.

For rescue service organizations who choose to use this appendix, a Rescue Plan Checklist (RPC) has been provided to assist them in developing a rescue plan for the PRCS they may have to enter. The RPC is designed so a rescue service organization can develop specific entry procedures with the participation of the host employer.

It is also realistic to assume that some rescue organizations, particularly fire departments, may not be given an opportunity for advance preparation with a host employer. This RPC is also designed to assist rescue organizations during these situations as well. Rescue personnel who are properly trained on PRCS operations can utilize the RPC to help identify any hazards and addresses control procedures and equipment needed.

Before proceeding to use the RPC, it is necessary that rescue personnel receive appropriate training. To assist with this task, the following general Standard Operating Procedures and training are suggested. Rescue organizations should modify their training and rescue plans accordingly to meet their specific situations. The elements of this program are arranged in the following manner: preplanning; training and standard operating procedures (SOPs).

Preplanning

Determine the various types of permit spaces which are likely to be encountered by rescue team members.

Designate on site command and control structure.

Designate rescue team members duties.

Note to the Rescue Service: Appendix J provides a sample of a non-mandatory letter which can be sent to employers by the rescue service to determine the presence of any permit spaces and their particular hazards.

APPENDIX L - RESCUE AND EMERGENCY SERVICES

Develop SOP for the permit spaces likely to be entered

Determine availability of appropriate rescue equipment, for example:

-- Combination oxygen and combustible gas monitors
-- Full-body harnesses
-- Mechanical winch
-- Reeves (collapsible) stretcher
-- Stokes stretcher -- Communication equipment
-- SCBAs/SAR
-- Ladders
-- Personal Protection Equipment
-- Explosion-Proof Lighting

Training

All members of the rescue team must receive training covering the following elements:

-- Permit space recognition
-- Permit space hazards
-- Control of permit space hazards
-- Atmospheric monitoring equipment and testing protocol
-- Use and maintenance of personal protective equipment
-- Rescue equipment
-- Simulate permit space rescues and required rescue techniques
-- Basic first aid and cardiopulmonary resuscitation (CPR)
-- Requirements stated in paragraph (k) and (g) of 1910.146
-- Train personnel on how to use rescue plan checklist (RPC)

Standard Operating Procedures (SOPs)

These SOPs are merely examples. Rescue organizations may use this information to develop their own SOPs.
-- Initiate on site command system
-- Utilize rescue plan checklist
-- If available, review entry permit
-- Determine number and condition of occupants in the permit space
-- If possible, attempt rescue without rescuers entering the permit space
-- If entry is necessary, institute entry procedures
-- Utilize rescue entry checklist, institute appropriate procedures and use required equipment
-- Secure area outside space and remove or control any potential hazards
-- Retrieving victims:
- Victim packaging-type required is indicated by the victims injuries and size of the opening
-- Provide necessary first aid/CPR and transport. Obtain material safety data sheets, if available, for thechemical to which the victim was exposed and provide this information to the hospital treating the individual(s).

APPENDIX L - RESCUE AND EMERGENCY SERVICES

Name	Rescue Duties	Rescue Equipment & PPE Authorized for Use	Trained in First Aid or CPR		Certified Yes/ No	Rescue Practice Date & Session Description	Name of Trainer & Date of Training

APPENDIX M - RESCUE PLAN CHECKLIST

APPENDIX N - ENTRY PERMIT FORM

ENTRY PERMIT (page 1 of 2)

GENERAL INFORMATION

Permit Space Location: __________________________________

Purpose of Entry: _______________________________________

Entry Permit Valid For: Date: __________ to Date: ________

Time: __________ to Time: ________

PERMIT SPACE HAZARDS

ATMOSPHERIC
Oxygen Deficiency	Y N
Oxygen Enrichment	Y N
Explosive (Gas/Vapor)	Y N
Explosive Dust	Y N
Carbon Monoxide	Y N
Hydrogen Sulfide	Y N
Other Toxic gases/vapors	Y N
ENGULFMENT	Y N
CONFIGURATION (ENTRAPMENT)	Y N
MECHANICAL	Y N
ELECTRICAL	Y N
SUBSTANCE HAZARDOUS TO SKIN OR EYES	Y N
HEAT STRESS	Y N
OTHER POTENTIAL HAZARDS (e.g., radiation, noise, etc.)	Y N

PERSONNEL

Entrant(s)	Time In	Time Out
_____________________________ _____________________________ _____________________________	________ ________ ________	________ ________ ________

Attendant(s) ____________________________________________

______________________________________________________

Entry Supervisor(s) _______________________________________

______________________________________________________

COMMUNICATION PROCEDURES USED BY ENTRANT(S) and ATTENDANT(S) Check all that apply

Visual Rope

Voice Radio

Other (specify)

CONTROLS/EQUIPMENT Check all that apply

ISOLATION LOCKOUT/TAGOUT

BLANKING/BLINDING

DOUBLE BLOCK AND BLEED

LINE BREAKING/MISALIGNMENT

OTHER

INERTING

PURGE/CLEAN

METHOD FOR SAFE COVER REMOVAL & SECURING AREA

ATMOSPHERIC TESTING

Periodic (give interval)

Continuous

VENTILATION

Natural

Continuous forced air

Local Exhaust

ENTRY EQUIPMENT

Ladders

Other

PERSONAL PROTECTIVE EQUIPMENT

Respiratory - SCBA, SAR, Air Purifying

Clothing (specify)

Eye and face protection

Hearing protection

RESCUE AND RETRIEVAL EQUIPMENT

Full body harness

Lifeline

Tripod w/mechanical winch

Explosion proof lighting

NON-SPARKING TOOLS

INTRINSICALLY SAFE ELECTRICAL EQUIP MENT & GFCI

COMMUNICATION EQUIPMENT

Radio

Phone

Other

HOT WORK PERMIT

FIRE EXTINGUISHERS

RESCUE AND EMERGENCY SERVICES

Names

Phone

__________________________________

Summoning Procedure

__________________________________

RESCUE PROCEDURES

______________________________________________

APPENDIX N - ENTRY PERMIT FORM

ENTRY PERMIT (page 2 of 2)

ATMOSPHERIC TESTING RECORD

CONDITION ACCEPTABLE LEVEL PRE-ENTRY READINGS ENTRY READINGS

(Reading) (Time) (Reading) (Time) (Reading) (Time) (Reading) (Time)

OXYGEN 19.5% - 23.5% ________ _______ ________ _______ ________ ______ ________ _____

EXPLOSIVE (GAS/VAPOR) <10% LFL ________ _______ ________ _______ ________ ______ ________ _____

EXPLOSIVE DUST <LFL (5 ft. Visibility) ________ _______ ________ _______ ________ ______ ________ _____

CARBON MONODIXE 50 ppm ________ _______ ________ _______ ________ ______ ________ _____

HYDROGEN SULFIDE 10 ppm ________ _______ ________ _______ ________ ______ ________ _____

___________________ ________________ ________ _______ ________ _______ ________ ______ ________ _____

OTHER HAZARDS

(e..g., heat stress) _________________ ________ _______ ________ _______ ________ ______ ________ _____

NAME(S) OF TESTER ________ ________ ________ _____

TESTING EQUIPMENT USED TYPE __________ SERIAL NO. __________ TYPE __________ SERIAL NO. __________

ENTRY AUTHORIZATION

ENTRY AUTHORIZED BY:

NAME _______________________________________

TIME ________________________________________

SIGNATURE _________________________________

DATE ________________________________________

POST ENTRY PERMIT AT ENTRANCE TO PERMIT SPACE

ENTRY CANCELLATION

ENTRY CANCELLED BY:

NAME ______________________________________

TIME ________________________________________

SIGNATURE __________________________________

DATE ________________________________________

REASON FOR CANCELLATION:

9 Entry Operations Completed

9 Prohibited Condition Arose (specify) ______________________________

____________________________________________

APPENDIX O - TRAINING LOG

Employee Name	Assigned Duty(s)

_________________________ _________________________

Date of Training Signature of Trainer(s)

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