Escolar Documentos
Profissional Documentos
Cultura Documentos
Date:
Date:
Location
description of confined space:
Job
No. and
Location
description of confined space:
Job
No.
Reason
for and
entry:
Reason
for entry:
Permit
issued
to:
Permit
issued
to:
Supervisors Name:
Supervisors
Name:
Attendants
name:
Attendants
name:
Permit
name:
Job
No.issuers
Job
No.issuers name:
%Permit
oxygen:
% lower explosive limit:
% oxygen:
% lower explosive limit:
ppm CO:
ppm CO:
H2S:
H2S:
Requirements
Requirements
Emergency Rescuer
EmergencyGas
Rescuer
Continuous
Monitor
Continuous
Gas Monitor
Barrier
for ground
openings
Barrier Signs
for ground openings
Warning
Warning Signs
yes
yes
yes
yes
yes
yes
yes
yes
no
nono
nono
nono
no
Job No.
Job No.
Date:
Date:
Job No.
Job No.
Floor
Floor
Nature of Job:
Nature of Job:
Welders Name:
Welders Name:
The above location has been examined. The precautions checked
has been
precautions
onThe
the above
reverselocation
of this card
haveexamined.
been takenThe
to prevent
fire. checked
on
the
reverse
of
this
card
have
been
taken
to
prevent
fire.
Permission is granted for this work.
Permission is granted for this work.
Permit
Permit
Expires
Expires
Date:
Date:
Time:
Time:
AM
AM
PM
PM
ppm CO:
ppm CO:
H2S:
H2S:
Requirements
Requirements
CAUTION
Opening in Ground
Keep Out !
Emergency Rescuer
EmergencyGas
Rescuer
Continuous
Monitor
Continuous
Gas Monitor
Barrier
for ground
openings
Barrier
for
ground
openings
Warning Signs
Warning
Signs
Safety Harness with life line
Safety/ Hoist
Harness
with life line
Tripod
/ Pulleyyes
Tripod / Hoist / Pulleyyes
yes
yes
yes
yes
yes
yes
yes
yes
yes
noyes
no
no
nono
nono
nono
nono
no
Date:
Date:
ppm CO:
ppm CO:
H2S:
H2S:
Requirements
Requirements
Emergency Rescuer
EmergencyGas
Rescuer
Continuous
Monitor
Continuous
Gas Monitor
Barrier
for ground
openings
Barrier
for
ground
openings
Warning Signs
Warning Signs
yes
yes
yes
yes
yes
yes
yes
yes
no
nono
nono
nono
no