Permit Required Confined Space Entry Permit

Permit Required Confined Space Entry Permit
***Notice***

Although this permit is not required for contractor Permit Required Confined Space Entry activities on a Pulsar Helium (the Company) location, it is made available as an example to contractors who provide services to Pulsar Helium. The Company requires contractors to utilize their company-provided permitting system when conducting Permit Required Confined Space Entry on a Company location.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Job Supervisor

First NameLast Name
Supervisor Email
example@example.com
Operating Group
Permit Location
Reason for Entry
Expected Duration of Entry
Note time in hours
Hazards

Are hazards present ?

Permit Space Hazards

Preparation Procedure

Rows	Required	Done
Pre-Entry Checklist
Pre-opening Hazards
Electrical lockout/tagout
Pneumatic Isolation
Hydraulic Isolation
Mechanical Isolation
Traffic Control/Barricading
Noise, Heat, Cold
Fall Protection
Ventilation Purge
Emergency Egress
Special Work

Required Equipment

Acceptable Entry Conditions

Rows	Yes	No
Review permit with attendant and entrant
Gas detector calibrated
All safety equipment available
Entry permit readily available
SDSs reviewed for chemicals used or present
Preparation/Isolation procedures completed
Pre-opening hazards eliminated
Traffic control/barricading satisfactory
Employees task trained
Attendant/entrant communication tested
Atmospheric tests satisfactory
Safeguards in place to prevent engulfment
Emergency services identified
Surrounding areas free from vapors and other hazards

Hazards