What
is the size (volume) and configuration
of the space?
What
tasks are performed during entry?
Questions
Have
employees received permit space
training?
Yes
No
Are
any hazardous atmospheres present
or potentially present?
Yes
No
Is
continuous forced air ventilation
needed to maintain acceptable
levels?
Yes
No
Is
air monitoring required?
Yes
No
If
yes, record test results.
Is
atmospheric testing equipment
calibrated?
Yes
No
Date
of calibration
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
Note:
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.
Is
an engulfment hazard present?
Yes
No
If
yes, what control measure is used
to eliminate the engulfment hazard?
Is
there an entrapment hazard?
Yes
No
If
yes, then list the steps to be
taken to eliminate the hazard.
Have
all hazardous energy sources (including
chemical and physical hazards)
been eliminated?
Yes
No
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:
Is
it necessary to enter the permit
space to determine if the hazard
has been eliminated?
Yes
No
If
yes, then the entry must be performed
in accordance with a full PRCS
program, paragraphs (d) through
(k).
Note:
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.
Have
all employees who will enter the
declassified space been instructed
to immediately evacuate the space
if a hazard is detected?
Yes
No
If
no, instruct employees of this
safety precaution measure.
Has
a procedure been instituted to
re-evaluate the space and reclassify
it back to a permit space if the
need arises?
Yes
No
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
Have
all employees participating in
the entry operation had an opportunity
to review this safe entry certification
form?
