Workplace Confined Space Entry Permit
Location of Confined Space:
[Sub-basement Level 2, Section D, Boiler Room] |
[Date]
Permit Validity Period: [08:00 AM to 04:00 PM on 29/11/2050]
Purpose of Entry:
[Inspection and maintenance of steam pipes]
Authorized Entrants:
[Name - Job Title]
[Name - Job Title]
[Name - Job Title]
Attendant:
[Your Name], [Your Contact Number]
Emergency Contact:
[Name - Job Title], [Your Contact Number]
Potential Hazards:
________________
________________
Safety Measures & Equipment:
_________________
_________________
Atmospheric Testing:
Oxygen Level: [19.5%]
Flammable Gases: [0 ppm]
Toxic Gases: [0 ppm]
Other: [N/A]
Communication Procedures:
[Continuous radio communication with the attendant]
Rescue/Emergency Procedures:
In case of emergency, use the intercom to alert the control room. Evacuate immediately if the alarm sounds. The emergency medical kit is located at the entrance.
Additional Notes:
All entrants have completed confined space training as of [October 2050].
Check for updates on weather conditions that may affect safety.
Approval (Signature):
________________
[Name - Job Title]
[Month Day, Year, Time]
Health & Safety Templates @ Template.net
