Confined Space Entry Log Submission

Confined Space Entry Log Submission

Submit your entry details and upload any related documents/photos here. By submitting this log you are agreeing that you, and your crew, are currently fit for the task and will follow all of your company's health and safety procedures and policies, while conducting yourselves in a professional manner. Most importantly, you are ready to handle and execute emergency procedures should the need arise.
Employee name:

First NameLast Name
Employee phone:
Please enter a valid phone number.Format: (000) 000-0000.
Employee email:
(Required only if you want a copy of your submission)
Who are you doing the entry for?
Examples: "Buckeye Terminals Tampa North, FL", "IMTT Bayonne, NJ", "Kinder Morgan Terminals Chesapeake, VA", etc.
Who is your client/site contact?
First and Last Name
What is their phone number?
Please enter a valid phone number.Format: (000) 000-0000.
Reason for entry/scope of work:
Examples: Tank cleaning, Adjust tank legs, Remove debris, etc.
Estimated start time:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Estimated time of completion:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Address of confined space:
Street Address, City, State (or best reference)
Location on the property:
Examples: Tank #, "Laydown Yard", etc.
Can you provide a copy (photo, scan, .PDF) of your confined space permit?
What type of confined space entry?

Other
If "Other", please describe:
How will entrants be accessing the confined space?
If "Other", please describe:
Are their any known liquids/vapors/gasses in the confined space?
Examples: "Gasoline", "Diesel", "No", etc.
Can you provide a copy (photo, scan, .PDF) of any safety data sheets of known contaminants?
What type of ventilation will be utilized?
When was your mulit-gas meter last successfully calibrated?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Did your multi-gas meter pass a bump test?
If applicable, what other types of air monitoring will you be conducting?
Examples: "Colormetric Tubes: Benzene", "Acid Gas", etc.
After your initial air reading, how often will you be taking additional air readings?
Are all headlamps/portable lighting being used intrinsically safe for use in flammable/explosive atmospheres (must be Division 1, Class 1)?
What are your initial PPE requirements?
Who is the entry supervisor?
First & Last Name
Who is the qualified attendant(s)
Names of all qualified attendants onsite
Who are the qualified entrants?
Names of all qualified entrants
What type of qualified rescue team do you have standing by?
Please provide the names/details of your rescue team?
Examples: Names of company personnel, "Pleasantville Fire Dept.", etc.
Upload confined space permit, safety data sheet(s), pics, etc.

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