Non-Permit Required Confined Space Entry Permit

Non-Permit Required Confined Space Entry Permit

ASE Safety Management System
***Notice***

Although this permit is not required for non-permit required confined space entry activities on a Arrow S Energy Operating (the Company) location, it is made available as an example to contractors who provide services to Arrow S Energy Operating. The Company requires contractors to utilize their company-provided permitting system when conducting non-permit required confined space entry work on a Company location.
Date

MonthDayYear
Date
Job Supervisor

First NameLast Name
Supervisor Email
example@example.com
Admin ServicesConstructionDrillingCompletionsSource WaterProductionMaintenanceWellservice/Workover
Permit Location
Reason for Entry
Expected Duration of Entry
Atmospheric Test Results
% of Oxygen (allowable level 19.5% to 23.5%):
% LEL (allowable level 0%):
Carbon Monoxide (allowable level 0%)
Hydrogen Sulfide (allowable level 0%)
Determination
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Acceptance
Entrant(s)
Entrant(s) Signature(s)
Attendant(s)
Attendant(s) Signature(s)
Supervisor Signature
Should be Empty:

Atmospheric Test Results