SAFETY POLICY

Confined Spaces SP# 1910.146

Quick Reference

1.0 Purpose
2.0 Scope and Applicability
3.0 Reference
4.0 Policy
5.0 General Responsibilities
6.0 Procedure
6.1 Definitions
6.2 General Provisions
6.2.1 Training
6.2.2 Confined Spaces
6.2.3 Hazards of Confined Spaces
6.2.4 Identifying Confined Spaces
6.2.5 Evaluating Confined Spaces
6.2.6 Permit-Required Confined Spaces Entry Requirements
6.2.7 Recordkeeping
6.3 General Responsibilities
6.3.1 Managers
6.3.2 Supervisors
6.3.3 Employees
6.3.4 Entrant
6.3.5 Attendant
6.3.6 Entry Supervisor
6.3.7 Qualified Person
6.3.8 Safety Risk Management
6.3.9 Division of Purchase and Services
APPENDIX A: Training Certification Form
APPENDIX B: Confined Space Inventory Form
APPENDIX C: Atmospheric Testing Procedure
APPENDIX D: Confined Space Evaluation Form
APPENDIX E: Confined Space Entry Permit
APPENDIX F: Confined Space Entry Program Element Contact List
APPENDIX G: Confined Space Entry Team Responsibilities
APPENDIX H: Confined Space Decision Tree Flowchart
APPENDIX I: Confined Space Entry Flowchart

1.0 Purpose

The purpose of this safety policy is to provide information and guidance for the protection of
North Carolina Department of Environment and Natural Resources (NCDENR) employees
who work around or enter confined spaces.

2.0 Scope and Applicability

A confined space/area by design has limited openings for entry and exit; has unfavorable
natural ventilation, can contain or produce dangerous air contaminants, and is not intended
for continuous employee occupancy. Therefore, confined spaces can have, or create, hazards
for NCDENR employees who perform work activities in them. Confined spaces may be
permitted or non-permitted confined spaces. Confined spaces are located throughout the state
and are present at many NCDENR worksites, jobsites and facilities; as well as client facilities
served and inspected by NCDENR employees, each having its own set of hazards associated
with them.

This safety policy provides guidelines for the protection of NCDENR employees that must
work in or around confined spaces. It includes training components and discussion on what
defines a confined space. This safety policy lists practices to identify confined spaces and
notes the hazards of confined spaces. Additionally, it lists methods to evaluate confined
spaces and the requirements for permit-required confined space entry. This document also
provides recordkeeping requirements.

This safety policy details the areas of responsibility for NCDENR managers, supervisors,
employees, entrants, attendants, entry supervisors, qualified persons, Safety Risk
Management, and Division of Purchase and Services. It also applies to NCDENR employees
who do not enter, but may be exposed to work around confined spaces.
This document applies to any operation that requires NCDENR employees to enter or work
inside any existing tank, tower, sewer, manhole, sump, vault, vat, processing vessel, pit,
tunnel, or similar confined spaces. This safety policy applies, but is not limited, to the
following NCDENR employees and operations:

Employees that enter trenches

Division of Marine Fisheries and Division of Parks and Recreation employees that
enter service areas below the weather deck of a vessel, excluding the engineering
room below a deck
Any maintenance employee that works in pipes or culverts
Storm Water Runoff Permitting employees that must enter storm water runoff
culverts, pipes or specified bridge areas
Employees that conduct inspections of sewage and water treatment facilities located
at municipal and company sites
Employees that must access manholes, whether they enter them or not
Maintenance employees that work in catch basin areas
Employees that enter sewer lift stations for inspection, operational or maintenance
service
Employees that use and/or maintain grease pits at maintenance or equipment shops
Employees that enter caissons/drilled shafts
Aquarium, Museum, and Zoo employees that enter and access certain animal/marine
life holding cells, tanks and maintenance access areas
Waste Management employees who perform storage tank inspections

3.0 Reference

This safety policy is established in accordance with Occupational Safety and Health
Standards for General Industry (29 CFR 1910.146), Occupational Safety and Health
Standards for the Construction Industry (29 CFR 1926.65), Occupational Safety and Health
Standards for the Maritime Industry (29 CFR 1915.11-16) and the NC Office of State
Personnel's Workplace Safety Requirements policy (WRP 1910.146).
4.0 Policy

It is the policy of NCDENR to provide a place of employment that is free from recognized
hazards to its employees and the general public by utilizing a proactive approach to safety.
Therefore, at each NCDENR facility and/or jobsite, confined spaces will be identified and, as
applicable, permitted and posted with warning signs. All confined spaces shall initally be
considered permit-required confined spaces until pre-entry procedures confirm that
conditions are not present to do so.

When a confined space hazard exists that cannot be eliminated, the following measures will
be implemented to minimize the hazards and to ensure the safety of employees and the
public:
engineering practices, administrative practices, safe work practices, Personal Protective
Equipment (PPE), and proper Confined Space Entry training.

NCDENR employees that provide on-site services to public or private facilities where
confined spaces are known to exist or may be present shall be trained to recognize the hazard
and the steps they may take to avoid injury from confined space dangers.

5.0 General Responsibilities

It is the responsibility of each manager, supervisor, and employee to ensure implementation

of NCDENR's safety policy on Confined Space Entry.

It is also the responsibility of each NCDENR employee to immediately report unsafe

conditions to his or her supervisor. Specific responsibilities are found in Section 6.3.

6.0 Procedure

This section provides applicable definitions, establishes general processes, and identifies
responsibilities required by NCDENR's Confined Space Entry safety policy.

6.1 Definitions

Attendant
Person who remains outside the permitted space while the work is being done.
Confined Space
A confined space by design has limited openings for entry and exit, may lack adequate
ventilation, and may contain or produce dangerous air contamination.

Entrant
A employee who is authorized by the employer to enter a permitted space.

Entry Permit
A written document that is provided by the employer to allow and control entry into a permit
required space.

Entry Supervisor
The person responsible for determining if acceptable entry conditions are present at a permit
space where entry is planned, for authorizing entry and overseeing entry operations, and for
terminating entry as required.

Hot Work Permits

A permit allowing employees to perform work involving welding, cutting, or any task that
would deplete oxygen, create toxic fumes and vapors, or create the potential for fire or
explosion.

Lower Flammable Limit (LFL)

The minimum concentration of a combustible/flammable gas or vapor in air which will ignite
if an ignition source is present.

Non-permit confined space

A confined space that does not contain or, with respect to atmospheric hazards, have the
potential to contain any hazard capable of causing death or serious physical harm.

Oxygen Deficiency
An atmosphere containing oxygen at a concentration of less than 19.5% by volume as
measured by an oxygen measuring device.

Oxygen Maximum
An atmosphere containing oxygen at a concentration of more than 23.5% by volume as
measured by an oxygen measuring device.
Permit-required confined space (permit space)
A confined space that has one or more of the following characteristics:

(1) Contains or has a potential to contain a hazardous atmosphere;

(2) Contains a material that has the potential for engulfing an entrant;
(3) Has an internal configuration such that an entrant could be trapped or asphyxiated by
inwardly converging walls or by a floor which slopes downward and tapers to a smaller
cross-section; or
(4) Contains any other recognized serious safety or health hazard.

Permit System
The employer's written procedure for preparing and issuing permits for entry and for
returning the permit space to service following termination of entry.

Qualified Person
A person who has been trained and authorized by the employer to perform atmospheric
testing.

Upper Explosive Limit (UEL)

The maximum concentration of a combustible/flammable gas or vapor in air before its
saturation point which will ignite if an ignition source is present.

6.2 General Provisions

This section notes the general areas of this safety policy with each area discussed in a
separate subsection. The sections are:

Training
Confined Spaces
Hazards of Confined Spaces
Identifying Confined Spaces
Evaluating Confined Spaces
Permit-Required Confined Space Entry Requirements
Recordkeeping

6.2.1 Training
The formal written confined space training program will provide employees with the
necessary understanding, skills, and knowledge to safely perform their jobs. The components
of this formal written training program include instruction on:

Types of confined spaces

Confined space hazards
Atmospheric testing of confined spaces
Cleaning and ventilation
Lockout of confined spaces
Personal Protective Equipment (PPE)
Respirator use and care
Buddy systems and emergency procedures
Communication procedures
Emergency rescue and procedures
Hot work (only where applicable to the employee's site or duty)

Initial and refresher training are to be provided to employees. Refresher training must be
conducted whenever an employee's duties change, whenever hazards in the confined space
change, or whenever an evaluation of the confined space entry program identifies
inadequacies in the employee's knowledge.

Employees designated to enter confined space work areas will be trained in the following
areas (this includes entrant, attendant, and rescue team):

Emergency entry and exit procedures

Applicable respirators
First Aid and CPR
Lockout barriers at worksites
Safety equipment use
Rescue equipment
Permit system
Work practices

Appendix A lists a training certification form to document the affected employee training on
confined space.
In addition to the above, the Qualified person shall be trained in:

Atmospheric testing methods

Meter calibration
Atmospheric behaviors of oxygen, combustible, and toxic gases

Qualified persons shall receive initial and refresher training.

NCDENR employees that provide on-site services to public or private facilities where
confined spaces are known to exist or may be present shall be trained to recognize the hazard
and the steps they may take to avoid injury from confined space dangers.

The components of this "confined space awareness" training shall include instruction on:

Types of confined spaces

Confined space hazards
Their division/office/program's practices/guidelines regarding confined spaces
Not entering a confined space unless they are trained to the Permit-Required Confined
Space Entry Requirements level

6.2.2 Confined Spaces

In NCDENR, a confined space is one that:

Is large enough for a person to enter and perform assigned work

Has entry and exit openings that may be limited in size and/or number
Is not intended for continuous human occupancy

Confined spaces in NCDENR can include any existing tank, tower, sewer, sewer station,
manhole, sump, vault, vat, grease pit, tunnel, or other similar confined spaces as shown in
Figure 1.

Figure 1
6.2.3 Hazards of Confined Spaces

Due to the nature of a confined space's shape, size, lack of ventilation, proximity to toxic
gases, and other contributing substances, confined spaces present many hazards to
employees. Potential confined space hazards include hazardous atmospheres, and general
safety hazards.

Hazardous atmospheres expose employees to the risk of death, incapacitation, injury, or

acute illness. Hazardous atmospheres include:

A flammable gas, vapor, or mist in excess of ten percent (10%) of its lower
flammable limit (LFL)
An airborne combustible dust at a concentration that obscures vision at a distance of
five feet or less
An atmospheric oxygen concentration below 19.5 percent or above 23.5 percent
An atmospheric concentration of any substance for which a permissible exposure
limit is published in Subpart Z of 29 CFR Part 1910 and could result in employee
exposure in excess of its permissible limit(s)
Any atmospheric condition recognized as immediately dangerous to life or health
(IDLH)

General safety hazards include but are not limited to:

Physical hazards
Structural hazards
Electrical hazards
Mechanical hazards
Biological hazards
Radiation hazards

Physical hazards include non-chemical, physiological stressors and include noise, vibration,
slick/wet surfaces, falling objects, temperature extremes, employee fatigue, and engulfment.

Structural hazards include confined space areas that may contain structural defects.
Electrical hazards include shock, burns, and/or electrocution due to exposed or ungrounded
electrical energy sources.

Mechanical hazards include any inadvertent mechanical movement of or within a confined

space that threatens the safety of the employee working in the confined space.

Biological hazards include bacterial action that can consume oxygen to produce carbon
monoxide or emit hydrogen sulfide or methane.

Radiation hazards include those sources that can inadvertently expose employees to
dangerous levels of radiation.

6.2.4 Identifying Confined Spaces at a Facility

All confined spaces at each NCDENR worksite/facility must be identified and located so the
permit-required confined space permit program can be established. Visually survey your
worksite/facility to identify confined spaces that are present and that will be included in the
confined space inventory list for your site. List all suspected confined spaces.

If a work space meets the confined space criteria, note it for inclusion into your
worksite/facility's confined space inventory. Appendix B provides a convenient format for
inventorying your confined spaces.

For non-DENR sites where DENR employees provide services and inspections, ask the
facility/site to provide you with a list of any confined space areas where you will be subject
to work in as part of your jobtask. Do not enter any confined spaces at those sites unless you
are trained to the Permit-Required Confined Space Entry Requirements level.

6.2.5 Evaluating Confined Spaces

Once all the confined spaces have been identified, then those confined spaces must be
evaluated to determine the hazards that may be present. Hazardous atmospheres and general
safety hazards must be evaluated for all the confined spaces.

A hazardous atmospheric evaluation must be conducted through atmospheric testing to

assess the conditions in the confined space. Appendix C lists atmospheric testing procedures
that will be followed by the qualified person. Results of the atmospheric testing should be
documented for later use.

General safety hazards should be assessed by visual observation. This observation should
include a visual assessment of:

Any engulfment potential;

The internal configuration of the confined space is such that the entrant could be
trapped or asphyxiated by inwardly converging walls or by a floor which slopes
downward and tapers to a smaller cross-section;
Other recognized serious safety or health hazards

Additionally, assessment should be based on knowing the existing conditions and normal
use/function of the confined space, along with the actual and potential hazards posed by
materials and substances in the confined space. Appendix D provides a Confined Space
Evaluation Form for use.

A confined space is a "permit-required confined space" if any of the above listed hazards
are present.

If none of these hazards are present, then the space or area is not designated as a permit-
required confined space.

If a change in use or configuration of a non-permit-required confined space increases hazards

to an entrant, then the space must be reevaluated for possible reclassification to a permit-
required confined space.

A permit-required confined space may be reclassified to a non-permit-required confined

space if:

The permit-required confined space poses no atmospheric hazards and all non-
atmospheric hazards are eliminated without entry
Entry is necessary to eliminate hazards and such entry is performed
In accordance with the confined space entry program, testing and inspection during
entry indicate that hazards have been eliminated
The basis for determining that all hazards are eliminated is documented and certified
Reclassification is effective only as long as the hazard(s) remain eliminated.

Surge flow and flooding. Employees who work in confined spaces that can suddenly be
flooded by rain, or receive flammable/hazardous effluent (e.g., sewer lift stations, manhole,
drain pipes and culverts) due to the emergency or accidental release by industry or
transportation accidents shall check the local weather bureau reports and be cognizant of
local weather conditions in order to plan, delay or stop the confined space work during such
events.

6.2.6 Permit-Required Confined Space Entry Requirements

The permit system for each worksite/facility shall include a listing of all permit-required
confined spaces, a warning sign/label at each permit-required confined space, and permit
issuance by a qualified supervisor or safety professional.

Once all permit-required confined spaces are identified, each one will be marked with a sign
(examples shown in Figure 2) advising personnel and the general public as to the dangers
involved. Where practical, all permit-required confined spaces will be locked or blocked to
prevent entry.

A qualified entry supervisor must authorize entry, prepare and sign written permits, order
corrective measures if necessary, and cancel permits when work is completed. The entry
permit is completed and posted in a conspicuous location near the entrance. Permits must be
available to all permit space entrants at the time of entry and should extend only for the
duration of the task. They must be retained for a year to facilitate review of the confined
space program.

Figure 2
Once all permit-required confined spaces have been identified, no employee may enter that
space until several requirements are met. These requirements include:

Establishing a permit system

Conducting pre-entry atmospheric testing
Isolating energy sources (lockout/tagout)
Ventilating and cleaning the confined space
Posting permit-required confined spaces with the appropriate warning signs
Having appropriate PPE
Having appropriate tools in place
Having attendants in place
Having rescue teams in place
Having provisions for contractor compliance with these requirements

Pre-entry atmospheric testing for the confined space shall be performed prior to employee
entrance. See Appendix C for atmospheric testing procedures.

If welding is to be performed in the confined space (permit-required or non permit-required),

a hot work permit must also be obtained. See chapter 19, Welding, SP # 1910.252 for
additional information.

Appendix E shows a Confined Space Entry Permit. This permit must be completed prior to a
permit-required confined space entrance.
Appendix F shows a Confined Space Entry Program Element Contact List. These forms shall
be maintained at each facility or operation by the individual charged with administering the
Confined Space Permit Program.

Energy sources will be completely isolated by physical disconnection, double blocking,

bleeding, or by lockout/tagout procedures. Figure 3 shows some typical lockout/tagout
devices. Also, see chapter 7, SP# 1910.147, Lockout/Tagout, for additional details.

Figure 3
Ventilation and cleaning shall be performed to empty, flush, or purge spaces using outside
air, where feasible. Figure 4 shows a typical ventilation configuration to empty, flush, or
purge a confined space.

Figure 4

During pre-entry ventilation, the blowing duct outlet should be positioned for uniform
dilution and elimination of any hazardous atmospheric pockets as shown in Figure 5.

Figure 5

When a hazardous atmosphere is detected, ventilation will continue until:

The job is completed

The space has no harmful concentration of toxic gases or vapors and acceptable
oxygen concentrations

The atmosphere will be tested a minimum of 3 times until safe levels are maintained.

PPE
The appropriate PPE shall be worn based on the hazard(s) and include:

Eye and face protection

Head protection
Foot and leg protection
Body protection
Hearing protection
Respiratory protection
Hand and arm protection
Harness, safety belts, and lifelines
See chapter 15, SP# 1910.132, Personal Protective Equipment, for details on matching PPE
to the hazard.

Appropriate equipment and tools must be in place and in good condition. See chapter 16,
SP# 1910.241, Hand and Portable Power Tools, for additional details.

Attendant
The attendant shall be stationed immediately outside of the permit-required confined spaces
and shall:

Be trained in rescue protocols

Not enter the permit-required confined space
Be within sight or call of the entrant
Have means to summon assistance
Have safety and rescue equipment on hand

The attendant shall be physically capable of assisting any employee inside the confined space
in the event of an emergency. This individual will be responsible for alerting others that a
rescue is in progress and for taking appropriate measures to ensure the safety of all co-
workers in the area.
No employee is to enter a confined space if another employee goes down! The attendant
shall always seek assistance.

Appropriate communications shall be established, such as radios or walkie-talkies, if the

employee gets out of sight or hearing range.

Rescue teams must be available for permit-required confined spaces. Rescue equipment and
self contained breathing apparatus must be available.

Contractors who perform permit-required confined space entry must comply with all the
OSHA requirements.

6.2.7 Recordkeeping

Recordkeeping requirements include:

 Retaining each canceled permit for at least one year to facilitate review of Permit-
Required Confined Spaces program
Noting problems encountered during entry on the permit to facilitate revisions to the
program
Certification of training with name, identity of trainers and training dates
Reclassification from permit to non-permit space certification with date, location, and
signature of person making determination

6.3 General Responsibilities

6.3.1 Managers

Managers are responsible for ensuring that adequate funds are available and budgeted for the
purchase of confined space equipment for their affected employees. They will also be
responsible for identifying the employees affected by this safety policy.

Managers shall be responsible for ensuring that confined spaces at their worksite/facility are
identified and labeled. Additionally, they will be responsible for ensuring all confined spaces
are evaluated to determine if a permit is required prior to entry. Managers shall also designate
entry supervisors and qualified persons. Managers will obtain and coordinate the required
training for affected employees. Managers will also ensure compliance with this safety policy
through their auditing process.

6.3.2 Supervisors

Supervisors will not allow any employee who has not received the required training to
perform any of the tasks or activities associated with this safety policy.

Supervisors will be responsible for communicating appropriate needs to managers and/or

supervisors.

Supervisors will be responsible for knowing where confined and permit-required confined
spaces are located at their worksite/facility. They will also be responsible for ensuring permit-
required confined spaces are posted with warning signs.

Supervisors will ensure employees are provided with PPE as necessary for their job.
Supervisors are responsible for ensuring that only employees trained and qualified will
operate material handling equipment.

Supervisors will be responsible for ensuring that the training required in this safety policy is
provided to employees that provide services to public or private facilities that have confined
space issues.

As applicable, supervisors will request that air monitoring data be evaluated by an Industrial
Hygienist for completeness, accuracy, and precision.

6.3.3 Employees

Employees shall comply with all applicable guidelines contained in this safety policy and
with division/program site specific practices and guidelines related to confined space.

It is the responsibility of the employee to follow all instructions pertaining to confined

spaces. Employees are never to enter confined spaces unless authorized by training and job
duties.

Employees that provide service to public or private water and sewer treatment facilities are
responsible for inquiring about any confined space issues at those facilities and notifying
their immediate supervisor of any thus noted.

6.3.4 Entrant

The entrant does the assigned task and is responsible for reviewing the permit before entry.
Appendix G lists additional details on the entrant's responsibilities.

6.3.5 Attendant

The attendant is responsible for maintaining communication with the entrant at all times.
Appendix G lists additional details on the attendant's responsibilities.

6.3.6 Entry Supervisor

The entry supervisor is responsible for ensuring that only confined space trained employees
are allowed to enter confined spaces. The entry supervisor is responsible for ensuring proper
permits and safety procedures are followed closely at the jobsite.

The entry supervisor must also be familiar with all hazards associated with the entry
operation. He is responsible for all safety precautions, rescue procedures, and safety
equipment needed for the operation. Appendix G lists additional details on the entry
supervisor's responsibilities.

6.3.7 Qualified Person

The Qualified person is responsible for checking the atmosphere of a confined space and
correctly reading and using the gas detection instruments. This individual will request from
the manufacture guidelines for using the air monitoring and gas detection equipment that they
are using. This individual shall be responsible for conducting calibration of the air
monitoring/measuring equipment according to the manufactures requirements.
The Qualified Person is responsible for documenting all confined space atmospheric
measurements.

6.3.8 Safety Risk Management

Safety Risk Management will provide prompt consultative assistance to managers,

supervisors, or others as applicable on matters concerning this safety policy. Upon request,
Safety Risk Management will assist in securing the required training.

Where requested, training, expertise, and guidance for the qualified person on atmospheric
testing will be located.

To ensure effective implementation of this safety policy, Division/Office/Program Safety

Consultants and Safety Officers shall be responsible to provide consultative, training and
audit assistance on this safety policy for their Division/Office/Program.
6.3.9 Division of Purchase and Services

Division of Purchase and Services will ensure that any confined space equipment and
instruments purchased through their oversight have been reviewed by the requesting
Division/Office/Program's New Equipment Safety Review Subcommittee, or the staff Safety
Consultant, or Safety Officer prior to any new purchase.

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Click here for printable forms you can use from below.

APPENDIX A: Confined Space Training Certification Form

Location:___________________________________________________________________

Instructor:__________________________________________________________________

Employee Name:_________________________
Employee ID#:________________________

Has the OSHA required training been completed in the following categories?

Completion Instructor's Employee's

Topic
Date Signature Initial

Types of Confined Spaces

Confined Space Hazards

Atmospheric Testing of Confined

Spaces

Evaluating Confined Spaces

Cleaning and Ventilation

Lockout of Confined Spaces

PPE

Respirator Use and Care

Buddy System and Emergency

Procedures

Communication Procedures

Emergency Rescue

Employee designated to enter

confined spaces (includes entrant,
attendant, and rescue team) shall
also be trained in the following
topics

Emergency Entry and Exit

Procedures

Applicable Respirators

First Aid and CPR

Lockout Barriers at Worksites

Safety Equipment at Worksites

Rescue Equipment

Permit Systems

Work Practices

Use and Retain a Course Roster for classes with more than five employees
(Printable form here)

APPENDIX B: Division/Office/Program Confined Spaces Inventory

DENR Facility/Work Site:_____________________________________________

Location:____________________________________________
 Inventory Date:_______________________________________

All permit-required confined spaces shall be posted with signs stating it is permit-
required.

Confined Work Space or Area

Permit Req'd
Purpose Hazard Work Done
(y/n)
This inventory must be kept up to date. All operational changes shall be evaluated for
impact on this facility's confined spaces.

APPENDIX C: Atmospheric Testing Procedures

A qualified person shall test spaces a minimum of three (3) times at all levels immediately
prior to entry. Figure 6 illustrates the common gases found at each of these levels.

Using a calibrated direct-reading instrument with remote sampling capacity, the qualified
person shall test for oxygen content, for flammable gases and vapors, and for potential toxic
air contaminants, in that order. The testing shall assess for:

Oxygen level (19.5 percent minimum/maximum 22 percent)

Potential flammable hazards (not to exceed 10% of its Lower Flammable Limit
(LFL))
Toxic materials known or expected to be present (Hydrogen sulfide 10ppm Max)
(other gases must be less than the known Threshold Limit Values (TLV) for that gas)

Figure 6

The qualified person shall record all atmospheric test results on the permit. A qualified
person shall perform atmospheric testing while the employee is inside the confined space/area
as follows:

At intervals depending on changing conditions

No less frequent than hourly
Continuously

Each testing instrument shall be:

 Calibrated per manufacturer's instructions (instruments out of calibration or that fail
field checks cannot be used until calibrated).
At least annually calibrated by the manufacturer.
Field checked immediately prior to use. This field check shall include checking with a
test gas as proscribed by the equipment's manufacture.

APPENDIX D: Confined Space Evaluation Form

Space:_____________________________ Location:_________________________
Date:______________________________ Evaluator:________________________
Answer the following questions about this confined space.
Hazard Determination
Yes No
Is there an engulfment potential?
Does the internal configuration restrict entry or exit (converging walls or
sloping and tapered floors)?

Atmospheric Testing

Is the measured oxygen content below 19.5 or above 23.5 percent? If not, whats the
measurement? __________________________________%
Are flammable gases, vapors, and mists above 10 percent of the lower flammable limit? If
not, whats the measurement? ___________________%
Are airborne combustible dusts at or above the lower flammable limit? If not, whats the
measurement? ___________________________________
Are toxic contaminants in excess of the Permissible Exposure Limit (PEL) and are they
capable of causing death, incapacitation, etc.?
Are there any other atmospheric conditions that are immediately dangerous to life or
health? If so, what are they?___________________________
If any of the above questions were answered yes, then the confined space is a permit-
required confined space.
APPENDIX E: Confined Space Entry Permit
(Valid for one 8-hour shift only)

All copies of permit will remain at jobsite until job is completed

Location and Description of Confined
Date:__________________________
Space:___________________________________________
Scheduled Work to be Time
Done:___________________________________ Started:________________________
Time
Division/Branch:______________________________________
Completed:_____________________
Persons Authorized to Enter:_________________________________________________________

Supervisor(s) in Charge of Crew Type of Crew Phone/Pager

Number

___________________________________________________________________________
___

SPECIAL REQUIREMENTS Yes No Yes No

LockOut - De-energize Escape Harness Escape Harness
Lines Broken - Capped or Blanked Tripod emergency escape unit
Purge - Flush and vent Lifelines Lifelines
Ventilation Fire Extinguishers Fire Extinguishers
Secure Area Spark Resistant Lighting Spark Resistant Lighting
Breathing Apparatus Protective Clothing Protective Clothing
Resuscitator - Inhalator Respirator (Air Purifying) Respirator (Air Purifying)
Hot Work Permit

ATMOSPHERIC Levels: Periodic Checks

Levels:
CHECKS Checks after
P.E.L.* At Initial Hr Hr Hr Hr Hr Hr Hr Hr
(Valid for one 8-hour Isolation
Check 1 2 3 4 5 6 7 8
shift only) and Ventilation
 19.5% to
% of Oxygen
21%
Any % over
% of L.E.L. * *
10
Carbon Monoxide 35 ppm
Aromatic Hydrocarbon 10 ppm
Hydrocyanic Acid 4.7 ppm
Hydrogen Sulfide 10 ppm
Sulfur Dioxide 2 ppm
Ammonia 25 ppm

Qualified Person (Atmospheric Tester) Name:

______________________________________________________________
Note: Continuous/periodic tests shall be performed throughout the job.

SAMPLING EQUIPMENT Name Type Date Calibrated Identification Number

ATTENDANT PERSON RESCUE PROCEDURES IN COMMUNICATION

(S) PLACE PROCEDURES

Yes

No

EMERGENCY PROCEDURES

If an emergency should occur-first summon help. Do not enter a confined space until
qualified help arrives and entry can be safely made. If a person is incapacitated for no
apparent cause you must assume that toxic gases or oxygen deficiency could exist-do not
enter without full protective gear and self contained breathing device.
Emergency Call #___________
Signed :
(Entry Supervisor)______________________________________________________
*P.E.L. Permissible Entry Level
**L.E.L Lower Explosive Level

APPENDIX F: Confined Space Entry Program Elements

Facility/Worksite:__________________________________

PROGRAM ELEMENT CONTACT

PERSON

Hazard Identification ____________________________________________

Hazard Control ____________________________________________
Written Permit System ____________________________________________
Posting Confined Spaces ____________________________________________
Training ____________________________________________
Special Safety Equipment ____________________________________________
Written Rescue Plan and Procedures ____________________________________________
External Hazard Protection ____________________________________________
Contractor Notification ____________________________________________
Communication Equipment ____________________________________________

NOTES: ________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

APPENDIX G: Confined Space Entry Team Responsibilities

A confined space team performs four functions:

The entrant does the work

The attendant (observer) who remains outside while the work is being done
The entry supervisor who authorizes permits
The rescue team who performs rescue

The entrant:

Does the assigned task

Reviews the permit before entry
Wears appropriate personal protective clothing, as required
Uses appropriate PPE, as required
Uses and attends to area and personal monitoring equipment
Pays attention to own physical reactions that could signal an unsafe condition
Maintains contact with the attendant and responds to evacuation orders
If the entrant senses any reaction to the environment, he or she should signal the
attendant for help, if necessary, and leave the confined space immediately

The attendant:

Reviews the permit before entry

Keeps track of who is in the space at all times
Keeps unauthorized people out of the area
Maintains continuous communication, visual or voice, with the entrant during the
entry
Makes sure the ventilation equipment, if used, is working
Monitors the atmospheric testing equipment
Attends to the lifeline, if worn by the entrant
Attends to the air line, if used, to prevent tangles and kinks
Remains alert for early symptoms of danger within the space
Watches for hazards outside and inside the space
Maintains clear access to and from the space
Notifies the entrant and orders evacuation if conditions warrant or if the permit limits
expire
 Is prepared to call for emergency help, if needed
Remains at the entry point unless relieved by another trained attendant

The Entry Supervisor (person authorizing permits) :

Plans each entry. Planning means to:

o Describe the work to be done
o Identify the workers involved
o Evaluate the hazards of the space
o Perform (or arrange for) atmospheric testing and monitoring
o Develop rescue plans
Ensures that the permit is complete, dated, and signed
Determines the need for certain equipment
Ensures atmospheric testing is conducted by qualified person and is acceptable
Ensures that all necessary procedures, and equipment for safe entry are in effect
Determines, at appropriate intervals, that operations remain acceptable
Cancels the permit and terminates the work if the conditions are not acceptable
Trains (or provides training for) all workers on the Confined Space Entry Team
Keeps records on training, safety drills, test results, equipment inspections, and
equipment maintenance.
Cancels the permit and secures the space when the work is done
Determines if a written rescue plan is necessary for a particular confined space entry
Verifies that emergency help is available and that the method of summoning help is
operable

APPENDIX H: Confined Space Decision Tree Flowchart

APPENDIX I: Confined Space Entry Flowchart

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