Non-Permit Confined Space Entry

Non-Permit Confined Space Entry
Status

OpenClosedCancelled
State
Project Name
Project Number
Reason For Cancellation
Date

MonthDayYear
Date
Entry Supervisor

First NameLast Name
Entry Supervisor Email
example@example.com
Authorized Entrant(s)
Authorized Attendant(s)
Entry Location
be specific
Reason for Entry
Expected Duration of Entry
Is this a printed/paper permit?

Yes
Upload printed permit or any supplementary documents

Browse Files

Cancelof
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%)
Confined Space Evaluation
1. Is the gas monitor current on calibrations

YesNo
2. Are test readings within the "Allowable Level"

YesNo
3. Is there a material that can engulf the entrant

YesNo
4. Could entrant be trapped, crushed or smothered

YesNo
5. Are there any additional uncontrolled safety hazards present

YesNo
6. Can the space be maintained as safe during work

YesNo
7. Are the entrants properly trained

YesNo
8. Are the attendants properly trained

YesNo
9. Are rescue procedures and equipment available

YesNo
10. Are attendants rotated every two hours

YesNo
*STOP*

Based on the above answers you provided, a Confined Space Entry Permit IS required. Please proceed with your plan by first meeting all the requirements of the Confined Space Entry Permit.
PROCEED

Based on the above answers you provided, a Confined Space Entry Permit is not required. Please proceed with your work. If conditions change or hazards arise, this permit must be cancelled and the approval process must start again.
Acceptance
Entry Supervisor Signature

Clear
Should be Empty:

Non-Permit Confined Space Entry

Atmospheric Test Results

Confined Space Evaluation

Acceptance