CONFINED SPACE PROCEDURE - Tetra Pak policies... · confined space procedure . ... 7...

Procedure ID: Confined Space Policy Johnny Srader Created Date: 03/17/2015, updated: 04/27/2015

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CONFINED SPACE PROCEDURE


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Table of Contents

1 PURPOSE ........................................................................................................................................................ 3

2 PROGRAM COMPLIANCE ................................................................................................................................ 3

3 SCOPE ............................................................................................................................................................ 3

4 DEFINITIONS .................................................................................................................................................. 3

5 RESPONSIBILITES ............................................................................................................................................ 6

6 HAZARD EVALUATION .................................................................................................................................... 7

7 PERMIT-REQUIRED CONFINED SPACE ENTRY DUTIES ..................................................................................... 7

8 PERMIT SPACE ENTRIES .................................................................................................................................. 9

9 ALTERNATE ENTRY PROCEDURES ................................................................................................................. 10

10 NON-PERMIT ENTRIES .............................................................................................................................. 10

11 CONFINED SPACE ENTRY EQUIPMENT ...................................................................................................... 11

12 AIR TESTING REQUIREMENTS ................................................................................................................... 11

13 EMERGENCY RESPONSE ............................................................................................................................ 12

14 CONTRACTORS ......................................................................................................................................... 12

15 TRAINING ................................................................................................................................................. 13

16 PROCEDURE REVIEW ................................................................................................................................ 14

17 APPENDICIES ............................................................................................................................................ 14

APPENDIX A: CONFINED SPACE ENTRY PERMIT ................................................................................................... 15


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1 PURPOSE

Employees working inside of a confined space are exposed to hazards such as engulfment, entrapment, and hazardous atmospheres that may not be present in normal work environments. This procedure provides Tetra Pak Inc. employees and supervisors clarity on the process to follow in order to conduct work inside of confined space in a safe manner.

2 PROGRAM COMPLIANCE

2.1 All Tetra Pak Inc. employees and contractors shall comply with the requirements of this procedure.

2.2 Violation of this procedure will result in will result in progressive disciplinary action in accordance with Tetra Pak policy.

2.3 A printed copy of this procedure shall be made available to all Tetra Pak Inc. employees and their authorized representatives.

3 SCOPE

3.1 This program applies to all Tetra Pak Inc. employees that will be working inside of a confined space or are involved in a confined space entry.

3.2 All Tetra Pak Inc. employees must refuse to perform work activities inside of a confined space if the requirements of this procedure cannot be met.

3.3 Tetra Pak Inc. employees will comply with customer-specific procedures when their requirements are more strict than this procedure.

3.4 This policy shall be effective June 15, 2015.

4 DEFINITIONS

4.1 Acceptable Entry Conditions: conditions that must exist in a permit space to allow entry and to ensure that employees involved with a permit-required confined space entry can safely enter into and work within the space.

4.2 Attendant: an individual stationed outside one or more permit spaces who monitors the authorized entrants and who performs all attendant's duties assigned in the employer's permit space program.

4.3 Authorized entrant: an employee who is authorized by the employer to enter a permit space.

4.4 Blanking or blinding: the absolute closure of a pipe, line, or duct by the fastening of a solid plate (such as a spectacle blind or a skillet blind) that completely covers the bore and that is capable of withstanding the maximum pressure of the pipe, line, or duct with no leakage beyond the plate.

4.5 Confined space: a space that:


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4.5.1 Is large enough and so configured that an employee can bodily enter and perform assigned work; and

4.5.2 Has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins, hoppers, vaults, and pits are spaces that may have limited means of entry.); and

4.5.3 Is not designed for continuous employee occupancy.

4.6 Double block and bleed: the closure of a line, duct, or pipe by closing and locking or tagging two in-line valves and by opening and locking or tagging a drain or vent valve in the line between the two closed valves.

4.7 Emergency: any occurrence (including any failure of hazard control or monitoring equipment) or event internal or external to the permit space that could endanger entrants.

4.8 Engulfment: the surrounding and effective capture of a person by a liquid or finely divided (flowable) solid substance that can be aspirated to cause death by filling or plugging the respiratory system or that can exert enough force on the body to cause death by strangulation, constriction, or crushing.

4.9 Entry: the action by which a person passes through an opening into a permit-required confined space. Entry includes ensuing work activities in that space and is considered to have occurred as soon as any part of the entrant's body breaks the plane of an opening into the space.

4.10 Entry permit (permit): the written or printed document that is provided by the employer to allow and control entry into a permit space and that contains the information specified in Section 7.

4.11 Entry supervisor: the person (such as the employer, foreman, or crew chief) 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 by this section.

NOTE: An entry supervisor also may serve as an attendant or as an authorized entrant, as long as that person is trained and equipped as required by this section for each role he or she fills. Also, the duties of entry supervisor may be passed from one individual to another during the course of an entry operation.

4.12 Hazardous atmosphere: an atmosphere that may expose employees to the risk of death, incapacitation, impairment of ability to self-rescue (that is, escape unaided from a permit space), injury, or acute illness from one or more of the following causes:

4.12.1 Flammable gas, vapor, or mist in excess of 10 percent of its lower flammable limit (LFL);

4.12.2 Airborne combustible dust at a concentration that meets or exceeds its LFL;

NOTE: This concentration may be approximated as a condition in which the dust obscures vision at a distance of 5 feet (1.52 m) or less.

4.12.3 Atmospheric oxygen concentration below 19.5 percent or above 23.5 percent;


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4.12.4 Atmospheric concentration of any substance for which a dose or a permissible exposure limit is published in Subpart G, Occupational Health and Environmental Control, or in Subpart Z, Toxic and Hazardous Substances, of this Part and which could result in employee exposure in excess of its dose or permissible exposure limit;

NOTE: An atmospheric concentration of any substance that is not capable of causing death, incapacitation, impairment of ability to self-rescue, injury, or acute illness due to its health effects is not covered by this provision.

4.12.5 Any other atmospheric condition that is immediately dangerous to life or health.

NOTE: For air contaminants for which OSHA has not determined a dose or permissible exposure limit, other sources of information, such as Material Safety Data Sheets that comply with the Hazard Communication Standard, section 1910.1200 of this Part, published information, and internal documents can provide guidance in establishing acceptable atmospheric conditions.

4.13 Hot work permit: Tetra Pak Inc. or customer written authorization to perform operations (for example, riveting, welding, cutting, burning, and heating) capable of providing a source of ignition.

4.14 Immediately dangerous to life or health (IDLH): any condition that poses an immediate or delayed threat to life or that would cause irreversible adverse health effects or that would interfere with an individual's ability to escape unaided from a permit space.

NOTE: Some materials -- hydrogen fluoride gas and cadmium vapor, for example -- may produce immediate transient effects that, even if severe, may pass without medical attention, but are followed by sudden, possibly fatal collapse 12-72 hours after exposure. The victim "feels normal" from recovery from transient effects until collapse. Such materials in hazardous quantities are considered to be "immediately" dangerous to life or health.

4.15 Inerting: the displacement of the atmosphere in a permit space by a non-combustible gas (such as nitrogen) to such an extent that the resulting atmosphere is non-combustible.

NOTE: This procedure produces an IDLH oxygen-deficient atmosphere.

4.16 Isolation: the process by which a permit space is removed from service and completely protected against the release of energy and material into the space by such means as: blanking or blinding; misaligning or removing sections of lines, pipes, or ducts; a double block and bleed system; lockout or tagout of all sources of energy; or blocking or disconnecting all mechanical linkages.

4.17 Line breaking: the intentional opening of a pipe, line, or duct that is or has been carrying flammable, corrosive, or toxic material, an inert gas, or any fluid at a volume, pressure, or temperature capable of causing injury.

4.18 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.

4.19 Oxygen deficient atmosphere: an atmosphere containing less than 19.5 percent oxygen by volume.


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4.20 Oxygen enriched atmosphere: an atmosphere containing more than 23.5 percent oxygen by volume.

4.21 Permit-required confined space (permit space): a confined space that has one or more of the following characteristics:

4.21.1 Contains or has a potential to contain a hazardous atmosphere;

4.21.2 Contains a material that has the potential for engulfing an entrant;

4.21.3 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

4.21.4 Contains any other recognized serious safety or health hazard.

4.22 Permit-required confined space program (permit space program): the employer's overall program for controlling, and, where appropriate, for protecting employees from, permit space hazards and for regulating employee entry into permit spaces.

4.23 Permit system: the written procedure for preparing and issuing permits for entry and for returning the permit space to service following termination of entry.

4.24 Prohibited condition: any condition in a permit space that is not allowed by the permit during the period when entry is authorized.

4.25 Rescue service: the personnel designated to rescue employees from permit spaces.

4.26 Retrieval system: the equipment (including a retrieval line, chest or full-body harness, wristlets, if appropriate, and a lifting device or anchor) used for non-entry rescue of persons from permit spaces.

4.27 Testing: the process by which the hazards that may confront entrants of a permit space are identified and evaluated. Testing includes specifying the tests that are to be performed in the permit space.

5 RESPONSIBILITES

5.1 Supervisors, Line Managers, and Functional OHS Leads

5.1.1 Enforcing the requirements of this procedure.

5.1.2 Ensuring provisions of equipment necessary for employee to protect themselves from confined space hazards.

5.1.3 Ensuring employees that will be involved with confined space entries have completed training.

5.1.4 Investigating incidents involving confined space entries.

5.2 Project Managers or Site Responsible

5.2.1 Determining if employees will be required to enter confined spaces.

5.2.2 Advising employees on when they will be required to enter into confined spaces at customer sites.


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5.2.3 Obtaining customer site-specific confined space entry procedures and hazard assessments of confined spaces that will be entered at the customer site and communicating requirements to employees.

5.2.4 Investigating incidents involving confined space entries.

5.2.5 Ensuring Tetra Pak Inc. employees and contractors comply with the requirements of this procedure at customer sites.

5.3 Employees

5.3.1 Complying with the requirements of this policy.

5.3.2 Inspecting and maintaining equipment required for confined space entries prior to use.

5.3.3 Understanding the hazards associated with the confined space or work activities to be performed inside of the confined space.

5.3.4 Using confined space entry equipment in the manner that it is designed to be used.

5.3.5 Completing confined space entry training.

6 HAZARD EVALUATION

6.1 Tetra Pak Inc. sites shall be surveyed to identity confined spaces.

6.2 Once identified, the confined space shall be evaluated to identify its hazards.

6.3 A confined space shall be classified as a Permit Required Confined Space (Permit Space) if it contains any of the following hazards:

6.3.1 Hazardous atmosphere;

6.3.2 Potential for engulfment;

6.3.3 Potential for entrapment; or

6.3.4 Mechanical or electrical hazards.

6.4 Confined spaces that do not contain any of the hazards listed in Section 6.3 shall be classified as Non-Permit Required Confined Spaces (Non-Permit Spaces).

6.5 Signs reading “DANGER – PERMIMT-REQUIRED CONFINED SPACE, DO NOT ENTER” shall be posted at all of the entry points of a permit space and the entry points shall be secured to prevent unauthorized entry.

6.6 Confined space surveys and hazard evaluations for Tetra Pak Inc. sites shall be maintained by the Building Manager.

7 PERMIT-REQUIRED CONFINED SPACE ENTRY DUTIES

7.1 Authorized entrants are required to:

7.1.1 Understand the hazards associated with the confined space entry and work activities conducted within the space;

7.1.2 Use personal protective equipment that is required by the entry permit;

7.1.3 Maintain communication with attendant;


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7.1.4 Exit the permit space as soon as possible when:

7.1.4.1 Ordered by the attendant;

7.1.4.2 They recognize signs or symptoms of exposure;

7.1.4.3 A prohibited condition exists; or

7.1.4.4 An automatic alarm is activated;

7.1.5 Alert the attendant when a prohibited condition exists or when warning signs or symptoms of exposure exist.

7.2 Attendants are required to:

7.2.1 Remain outside the permit space during entry operations unless relieved by another authorized attendant;

7.2.2 Perform non-entry rescues when specified by the employer’s rescue procedure;

7.2.3 Know existing and potential hazards, including information on the mode of exposure, signs or symptoms, consequences and physiological effects;

7.2.4 Maintain communication with and keep an accurate account of those workers entering the permit space;

7.2.5 Order evacuation of the permit space when:

7.2.5.1 A prohibited condition exists;

7.2.5.2 A worker shows signs of physiological effects of hazard exposure;

7.2.5.3 An emergency outside the confined space exists; and

7.2.5.4 The attendant cannot effectively and safely perform required duties;

7.2.6 Summon rescue and other services during an emergency;

7.2.7 Ensure that unauthorized people stay away from permit spaces or exit immediately if they have entered the permit space and report this instance to the authorized entrant and the entry supervisor;

7.2.8 Inform authorized entrants and the entry supervisor if any unauthorized person enters the permit space; and

7.2.9 Perform no other duties that interfere with the attendant’s primary duties.

7.3 Entry supervisors are required to:

7.3.1 Know space hazards including information on the mode of exposure, signs or symptoms and consequences;

7.3.2 Verify emergency plans and specified entry conditions such as permits, tests, procedures and equipment before allowing entry;

7.3.3 Terminate entry and cancel permits when entry operations are completed or if a new condition exists;

7.3.4 Verify that rescue services are available and that the means for summoning them are operable;

7.3.5 Take appropriate measures to remove unauthorized entrants; and


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7.3.6 Ensure that entry operations remain consistent with the entry permit and that acceptable entry conditions are maintained.

8 PERMIT SPACE ENTRIES

8.1 Entry permits

8.1.1 A confined space entry permit shall be completed prior to entering a permit space.

8.1.2 The confined space entry permit is only valid for one work shift.

8.1.3 Blank permits can be obtained from the Building Manager or Project Manager.

8.2 The procedure below shall be followed prior to entering a permit space:

8.2.1 Identify and evaluate the hazards of permit spaces;

8.2.2 Specify acceptable entry conditions;

8.2.3 Perform air monitoring of the space prior to entry and continuously during entry;

8.2.4 Isolate the permit space using lock-out/tag-out methods (i.e., lock and tag out compressed gas system on presses, lock out pumps and electrical connections in sumps, etc.);

8.2.5 Purge, inert, flush, or ventilate the permit space as necessary to eliminate or control atmospheric hazards;

8.2.6 Provide barriers as necessary to protect entrants from external hazards;

8.2.7 Verify that conditions in the permit space are acceptable for entry throughout the duration of an authorized entry;

8.2.8 Designate the communication methods that will be used between the entrant and the attendant;

8.2.9 Designate rescue requirements and place equipment needed next to the permit-required confined space in the event that an emergency rescue is needed;

8.2.10 Provide at least one attendant outside the permit space for the duration of entry operations;

8.2.11 Designate employees who have active roles in the entry process – Entry Supervisor, Entrant, Attendant, Rescue, etc.;

8.2.12 Verify Confined Space Entry Permit has been completed and signed by the Entry Supervisor; and

8.2.13 Ensure Permits are cancelled at the end of each shift, or when new hazards arise.

8.3 Upon completion of work in a permit space:

8.3.1 Remove and account for all materials brought into the confined space;

8.3.2 Close all hatches, ventilation and entry points;

8.3.3 Remove all Lock out / Tag out materials;

8.3.4 Cancel the permit;


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8.3.5 Forward the cancelled permit to the Building Manager or, if the entry was performed at a customer site, a copy of it to the Project Manager. Cancelled permits shall be retained for at least 12 months.

9 ALTERNATE ENTRY PROCEDURES

9.1 Alternate entry procedures may be used if the only hazard present in the confined space (as determined by the Entry Supervisor) is:

9.1.1 Atmospheric in nature; and

9.1.2 The atmospheric hazard can be controlled by mechanical ventilation alone; and

9.1.3 The Permit Space atmosphere will not become immediately dangerous to life and health (IDLH) if the mechanical ventilation fails.

9.2 After evaluating the “Permit Required Confined Space” and establishing appropriate atmospheric controls, the Entry Supervisor may reclassify the Permit Space as an Alternate Entry Space on the Confined Space Entry Permit.

9.3 Under Alternate Procedures, the Entrant may enter the confined space without the assistance or use of an attendant, following the procedure below:

9.3.1 Establish and ensure that the mechanical ventilation system is operating and providing clean, fresh air to the entrant’ s work location within the space during the entire entry;

9.3.2 Test the atmosphere of the space prior to entry into the space;

9.3.3 Use and continually operate a personal gas detector during the entire confined space operation;

9.3.4 Immediately evacuate the space if ventilation, or if the portable air sampling equipment, fails to enter alarm mode; and

9.3.5 Immediately evacuate the space if previously unrecognizable hazards are discovered. If this occurs, the Entry Supervisor shall be immediately notified. The Entry Supervisor shall re-evaluate the space and implement appropriate safety precautions prior to resuming the confined space operation.

9.4 Entry supervisor may act as Entrant during Alternate Entry Confined Space operations. No Attendant is necessary for Alternate Procedure entries, unless assistance is needed to accomplish safe entry and exit by the Entrants (i.e., tripod to enter a tank, etc.).

9.5 All steps taken to reclassify the Permit Space to an Alternate Entry Space must be written on the entry permit. All confined spaces shall be considered Permit-Required until the pre-entry procedures demonstrate otherwise.

10 NON-PERMIT ENTRIES

10.1 If the confined space poses no actual or potential atmospheric hazards, and if all hazards within the space are eliminated without entry into the space, the permit space may be


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reclassified as a non-permit confined space for as long as the non-atmospheric hazards remain eliminated.

10.2 If it is necessary to enter the permit space to eliminate hazards, such entry will be performed as a permit-required confined space entry.

10.3 If hazards arise while employees are working in a non-permit space, each employee shall exit the space immediately. The site shall then reevaluate the space and determine whether it must be reclassified as a permit space.

11 CONFINED SPACE ENTRY EQUIPMENT

11.1 Equipment required for confined space entries shall be provided and maintained by Tetra Pak Inc. at no cost to the employee.

11.2 Employees shall be trained on the use of equipment required for confined space entries.

11.3 Confined space entry equipment may include the following:

11.3.1 Testing and monitoring equipment;

11.3.2 Ventilating equipment;

11.3.3 Communications equipment;

11.3.4 Personal protective equipment;

11.3.5 Lighting equipment;

11.3.6 Barriers and shields;

11.3.7 Ladders or other equipment required for entry and egress; and

11.3.8 Rescue and emergency equipment

12 AIR TESTING REQUIREMENTS

12.1 The atmosphere within the space will be tested prior to entry to determine whether dangerous air contamination and/or oxygen deficient atmospheres exist inside of the space.

12.2 Continuous air monitoring shall also be conducted while personnel are working inside of a confined space, and readings documented every 15 minutes.

12.3 Air testing equipment shall be calibrated prior to testing and used by employees trained on its use.

12.4 The atmospheric testing shall be performed in the following order:

12.4.1 Oxygen between 19.5-21.5%;

12.4.2 Combustible gases less than 10% LEL;

12.4.3 Carbon monoxide gas less than 10 ppm;

12.4.4 Hydrogen sulfide gas less than 10 ppm; and

12.4.5 All other atmospheric hazards less than occupational exposure limits as established by OSHA, ACGIH, or the manufacture (refer to the Safety Data Sheet for the chemical).


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12.5 Observation of air testing

12.5.1 Authorized entrants or their authorized representatives shall have the opportunity to observe the pre-entry and any subsequent testing or monitoring of the confined space.

12.5.2 The permit space shall be reevaluated in the presence of any authorized entrant or their authorized representative who requests such reevaluation because the entrant or representative has reason to believe that the evaluation of that space may not have been adequate;

12.5.3 The authorized employees or their authorized representative shall immediately be provided with the results of any testing conducted in accordance with subsection.

13 EMERGENCY RESPONSE

13.1 Entry supervisor shall ensure that rescue personnel are readily available to rescue entrants and provide emergency services after rescue.

13.2 Prior to entry, procedures for summoning rescue personnel shall be identified on the confined space entry permit.

13.3 Retrieval systems and methods of non-entry:

13.3.1 Each authorized entrant will use a chest or full body harness, with a retrieval line attached at the center of the entrant’s back near shoulder level, above the entrant’s head, or at another point which Tetra Pak Inc. identifies as a profile small enough for the successful removal of the entrant.

13.3.2 Retrieval lines may be disconnected from the body harness where continual attachment introduces additional hazards, such as entanglement with internal equipment.

13.3.3 In the event of multiple entrants to a single confined space, when the nature of the confined space would cause the permanent attachment of retrieval lines to increase the potential for retrieval lines to become entangled with the lines of other workers or equipment while moving around, multiple common retrieval lines may be used, provided that the entrants connect their harness or wristlet to one of the retrieval lines when working in a fixed position.

13.3.4 Wristlets may be used instead of the chest or full body harness if Tetra Pak Inc. can demonstrate that the use of a chest or full body harness is infeasible or if it creates a greater hazard and that the use of wristlets is the safest and most effective alternative.

13.4 Unauthorized personnel shall be stopped from attempting a rescue.

14 CONTRACTORS

14.1 Contractors shall be:

14.1.1 Informed when the workplace contains permit spaces and that permit space entry is allowed only through compliance with this procedure;


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14.1.2 Apprised of the elements, including the hazards identified and experience with the space, that make the confined space a permit space;

14.1.3 Apprised of any precautions or procedures that Tetra Pak Inc. has implemented for the protection of employees in or near permit spaces where contractor personnel will be working; and

14.1.4 Debriefed at the conclusion of the entry operations regarding the permit spaced program followed and regarding any hazards confronted or created in permit spaces during entry operations.

14.2 Entry operations shall be coordinated with contractors when Tetra Pak Inc. employees and contractor personnel will be working in or near permit spaces.

14.3 Contractors who are hired to perform work at Tetra Pak Inc. are responsible for complying with the requirements of this procedure.

14.4 Tetra Pak Inc. employees who hire contractors are responsible for ensuring contractors have reviewed this procedure and for informing contractors when confined space entry permits are required.

14.5 Tetra Pak Inc. Site Responsible persons are responsible for ensuring that contractors comply with this procedure when working at customer sites.

15 TRAINING

15.1 Every employee at Tetra Pak Inc. who will participate in confined space entries shall be trained on entry procedures.

15.2 Training records shall include each employee’s name, identify the training provider, the dates of training, training related materials, , and certificates, shall be maintained by the Occupational Safety & Health Officer and shall be made readily available for inspection by employees or their designated representatives.

15.3 Employees shall be trained prior to initial assignment of duties related to confined space entries and annually thereafter.

15.4 Additional training shall be required when:

15.4.1 There is a change in permit space operations that presents a hazard about which an employee has not previously been trained; or

15.4.2 There is reason to believe either that there are deviations from the permit space entry procedures or that there are inadequacies in the employee's knowledge or use of these procedures.

15.5 Training for authorized entrants, attendants, entry supervisors, and rescue personnel shall cover the following topics:

15.5.1 General hazards associated with confined spaces.

15.5.2 Specific confined space hazards associated with the facility, location, or operation.


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15.5.3 Reason for, proper use, and limitations of personal protective equipment and other safety equipment required for entry into confined spaces.

15.5.4 Permits and other procedural requirements for conducting a confined space entry.

15.5.5 Conditions that would prohibit entry.

15.5.6 Emergency response procedures.

15.5.7 Duties and responsibilities of the confined space entry team.

15.5.8 Symptoms of overexposure to probable air contaminants in themselves and co-workers, and method(s) for alerting the attendant(s).

15.5.9 Use of emergency equipment to conduct non-entry rescues.

15.6 Rescue personnel shall additionally be trained on:

15.6.1 Use of emergency equipment to conduct entry rescues;

15.6.2 First aid and CPR

15.7 Employees performing atmospheric testing and monitoring shall be trained on the following:

15.7.1 Proper use of testing equipment;

15.7.2 Calibration of testing equipment;

15.7.3 Sampling strategies and techniques; and

15.7.4 Exposure limits for anticipated contaminants.

16 PROCEDURE REVIEW

16.1 This procedure shall be reviewed annually to revise the procedure as necessary to protect employees from confined space hazards.

16.2 The review shall include all of the cancelled confined space entry permits performed in the preceding 12 months.

17 APPENDICIES

17.1 Appendix A: Confined Space Entry Permit

APPENDIX A: CONFINED SPACE ENTRY PERMIT

Confined Space Location/Description/ID Number Date:

Purpose of Entry

Time In:

Time Out:

Permit Canceled Time:

Reason Permit Canceled:

Supervisor:

Rescue and Emergency Services: _________________________________________________

Hazards of Confined

Space

Yes No Special Requirements Yes No

Oxygen deficiency Hot Work Permit Required Combustible gas/vapor Lockout/Tagout Combustible dust Lines broken, capped, or blanked Carbon Monoxide Purge-flush and vent Hydrogen Sulfide Secure Area-Post and Flag Toxic gas/vapor Ventilation Toxic fumes Other- List: Skin- chemical hazards Special Equipment Electrical hazard Breathing apparatus- respirator Mechanical hazard Escape harness required Engulfment hazard Tripod emergency escape unit Entrapment hazard Lifelines Thermal hazard Lighting (explosive proof/low voltage) Slip or fall hazard PPE- goggles, gloves, clothing, etc. Fire Extinguisher

Communication Procedures:

DO NOT ENTER IF PERMISSABLE ENTRY LEVELS ARE EXCEEDED

Test Start and Stop Time: (24 Hour Clock)

Level Measured

Permissible Entry Level Start Stop

% of Oxygen 19.5 % to 23.5 % % % of LFL Less than 10% % Carbon Monoxide 35 PPM (8 hr.) PPM Hydrogen Sulfide 10 PPM (8 hr.) PPM Other

Name(s) or Person(s) testing:

Gas Testing Instrument(s) used- Include Name, Model, Serial Number and Date Last Calibrated:

CONTINUAL AIR TESTING RESULTS IMMEDIATELY EVACUATION IF PERMISSABLE ENTRY LEVELS ARE EXCEEDED

Time Level Time Level Time Level Time Level

%Oxygen % % % %

% of LFL % % % %

Carbon Monoxide PPM PPM PPM PPM

Hydrogen Sulfide PPM PPM PPM PPM

Other:

Authorized Entrants Authorized Attendants

PERMIT AUTHORIZATION I Certify that all actions and conditions necessary for safe entry have been performed.

Name-Print (Entry Supervisor):

Signature:

Date: Time:

Entry Procedure Checklist: Complete the following steps before, during, and after a confined space entry: Step 1 Obtain a Permit-Confined Space Entry Form from Tetra Pak Inc. Site Representative or Building Manager. Step 2 Notify Supervisor before the Confined Space Entry.

Step 3 Verify gas testing instrument has been calibrated and is in working order.

Step 4 Complete the top portion of the Confined Space Entry Permit form.

Step 5 Ensure all rescue equipment (e.g. tripod, body-belt, lanyard) is in place prior to entry.

Step 6 Monitor the confined space with the gas testing instrument prior to entry. The entrant and attendant should sign the permit authorization section on the bottom of the permit to ensure all actions and conditions necessary for safe entry have been performed.

Step 7 Continuously test the air if there is a potential for a hazardous atmosphere during the entry. The employee should also have a full body harness and lanyard attached to the rescue tripod. Employee shall have a means for communication, such as a radio, and any other necessary personal protective equipment.

Step 8 Employee can enter the confined once Step 7 is completed. The entrant and attendant should complete the Hazards of Confined Spaces and Special Requirements Section of the Permit-Confined Space Entry Form once the employee is within the confined space. The entrant should also gather the % Oxygen, % Explosive Gases, Carbon Monoxide, and Hydrogen Sulfide readings and communicate them to the attendant to place on the Permit Form.

Step 9 The attendant should maintain constant communication with the entrant until the entrant has exited the confined space.

Step 10 The attendant should contact Entry Supervisor once the entrant has exited the confined space.

Step 11 The Permit-Confined Space Entry Form should be given to Tetra Pak Inc. Site Representative or Building Manager, to file in the Confined Space Records

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