YES NO Respiratory Protections ( ) ( ) Are MSHA/NIOSH- approved respirators of the type required available at the worksites? ( ) ( ) Is respiratory protection required (e.g. air purifying, supplied air, self-contained breathing apparatus, etc.)? If so, specify type: Training ( ) ( ) Have you been trained in proper use of respirator? ( ) ( ) Have you been trained in confined space entry and do you know what to look for? Standby/Rescue ( ) ( ) Will there be a standby person on the outside in constant visual or auditory communication with the person on the inside? ( ) ( ) Will the standby person be able to see and/or hear the person inside at all times? ( ) ( ) Has the standby person(s) been trained in rescue procedures? ( ) ( ) Will safety lines and harnesses be required to remove a person? ( ) ( ) Are company rescue procedures available to be followed in the of an emergency? ( ) ( ) Are you familiar with emergency rescue procedures? ( ) ( ) Do you know who to notify and how in the event of an emergency? This Confined Permit Application has been reviewed and entry has been approved based upon the conditions that exist as described within this document. Should conditions change, the permit shall be withdrawn, the space vacated and a new evaluation will be conducted. Permit Authorized by: .
YES NO Respiratory Protections ( ) ( ) Are MSHA/NIOSH- approved respirators of the type required available at the worksites? ( ) ( ) Is respiratory protection required (e.g. air purifying, supplied air, self-contained breathing apparatus, etc.)? If so, specify type: Training ( ) ( ) Have you been trained in proper use of respirator? ( ) ( ) Have you been trained in confined space entry and do you know what to look for? Standby/Rescue ( ) ( ) Will there be a standby person on the outside in constant visual or auditory communication with the person on the inside? ( ) ( ) Will the standby person be able to see and/or hear the person inside at all times? ( ) ( ) Has the standby person(s) been trained in rescue procedures? ( ) ( ) Will safety lines and harnesses be required to remove a person? ( ) ( ) Are company rescue procedures available to be followed in the of an emergency? ( ) ( ) Are you familiar with emergency rescue procedures? ( ) ( ) Do you know who to notify and how in the event of an emergency? This Confined Permit Application has been reviewed and entry has been approved based upon the conditions that exist as described within this document. Should conditions change, the permit shall be withdrawn, the space vacated and a new evaluation will be conducted. Permit Authorized by: .