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
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
D.
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
6)
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
9)
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
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
Determine victim=s immediate needs, if
possible remove victim promptly
Rescuer must never remove their respirator
face piece to administer fresh air to
the victim
If victim is trapped and can not be move
promptly :
1.
Provide air to the victim with SCBA
or SAR
2.
Oxygen cylinder must not be taken into
a permit space if the oxygen could react
with any substances in the space and
create an additional hazard.
--
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.)