PERMIT-REQUIRED
CONFINED SPACE (PRCS) PROGRAM WORK
SHEET
Entry Permit: Enter
company representatives name
is our designated Confined Space Co-ordinator
(CSC). The CSC 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 to the CSC. The CSC
will review entry operations if measures
taken did not fully protect employees
and will conduct a review of the permit
program at least annually utilizing
canceled entry permits. Any inadequacies
will be corrected.
Permit
Space Location
What
is the size (volume) and configuration
of the space?
What
tasks are performed during entry?
Hazards
Acceptable
Entry Conditions
Equipment
Required
Yes/No
Type
Air
testing monitor
Y
N
Forced
air ventilation
Y
N
Communication
Y
N
Personal
Protective Equipment
Y
N
Lighting
Y
N
Barriers
Y
N
Entry/Egress
Y
N
Rescue
Equipment
Y
N
Respirator
Y
N
Other
Equipment
Y
N
Methods
to prevent Unauthorized Entry
Specific
Space Entry Procedures
Designated Required Personnel
Authorized
Entrant's Name(s)
Duties
:
Attendant's
Name(s)
Duties
:
Is
one attendant monitoring multi-spaces
at the same time? Yes
No
If
yes, list method(s) to monitor
multi-spaces
Provide
procedure(s) to respond to an
emergency and still be able
to ensure the safety of the
other spaces
Entry
Supervisor's Name(s)
Duties
:
Air
Monitor's Name(s)
Duties
:
Procedures
for Summoning Rescue and Emergency
Services
Multi-Employer Permit Space
Operation? Yes
No
If
yes, develop procedures to coordinate
entry operations
List
measures taken to close entry
portal and return the space
to normal operating conditions
