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.
Permit Space Location
What
is the size (volume) and configuration
of the space?
What tasks are to be performed
during the entry operation?
Questions
Yes
No
Have
employees received permit space
training?
Y
N
Has the certifier received permit
space training?
Y
N
Is
a hazardous atmosphere the only
hazard of concern?
Y
N
If
no, alternative procedures cannot
be used.
Does
the atmospheric hazard in the
space have the potential to
create high temperatures or
high pressures?
Y
N
If
yes, take appropriate action
before removing cover
Are
conditions safe to remove cover?
Y
N
If no, cover removal is prohibited
After
cover removal, is opening properly
guarded?
Y
N
List guarding methods:
Continuous
forced air ventilation provided?
Y
N
If
no, explain why. If yes, explain
capacity (CFM) air exchange
rate.
Minimum ventilation duration
prior to allowing entry
Is
atmospheric testing equipment
calibrated?
Y
N
Date
of calibration:
Atmospheric Testing Record
Substance
Acceptable
Level
Readings
Oxygen
19.5% - 23.5%
Explosive Carbon (Gas/Vapor)
<10%
LFL
Explosive
Dust
Carbon
Monoxide
50
PPM
Hydrogen
Sulfide
10
PPM
Does
inspection of interior have
to be conducted to see if other
hazards exist
Y
N
If
yes, full entry program is required.
Is
frequent or periodic testing
performed?
Y
N
If
no, explain why
Who
is to perform frequent or periodic
monitoring?
If
a hazardous atmosphere is detected
during entry, have employees
been instructed to evacuate
immediately?
Y
N
Is
there a procedure to reevaluate
the space if a hazardous atmosphere
does develop?
Y
N
Describe
Procedure:
Have
steps been taken to prevent
employees from re-entering the
space until it is proven to
be safe?
Y
N
List
steps
Have
employees had the opportunity
to review the data to support
use of alternative procedures?
