Confined Space Organizational Chart - Santa Clara County Fire Department
Confined Space Organizational Chart Positions MUST be CONFINED SPACE Rescue certified: Rescue Group Supervisor Assistant Safety Officer / USAR TSO Attendant Entrants
Fire Department Confined Space Entry Permit Emergency Event Training Event Other Incident Location: Type of Confined Space: Type of work being performed: Site Representative: Cell Phone #: Date: Time: Jurisdiction: Incident Number: Incident Commander: Operations Section Chief: Safety Officer: CAL/OSHA Rep: Incident Size-Up Establish control zones and secure perimeter Number of victim(s) , and Determine survivability profile: Determine nature of incident: Fire Trapped RESCUE Medical RECOVERY Hazmat Other Establish ICS positions and distribute appropriate Tactical Worksheets Confined Space Hazards Detailed check lists and monitoring logs refer to Tactical Worksheets Identify and abate hazards associated with the space: (Lock-out / Tag-Out) Electrical Solar Generator Gas Atmospheric Mechanical Engulfment Physical Configuration Environmental Other Establish atmospheric monitoring: (For more log area refer to Atmospheric Monitoring Unit Leader Worksheet) LEL Instrument(s): TMX412 / BW Micro / BW Max / Other: Colorimetric Tubes or other type of monitoring equipment: Initials: Gases monitored Time Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Meter: Meter: Meter: Establish ventilation immediately after initial atmospheric monitoring is complete Ventilation method used: Page 1 of 3 Positive Pressure Exhaust Combination July 20, 2012 Special LEL
Fire Department Confined Space Entry Permit Required Positions Assignments (Bold must be Confined Space Rescue Operational Certified) Rescue Group Supervisor (Cal OSHA Required) Assistant Safety Officer/ USAR TSO Attendant (Cal OSHA Required) Primary Entrant #1 (Cal OSHA Required) Primary Entrant #2 Back-up Entrant #1 Back-up Entrant #2 Breathing Support Unit Leader Rigging Team Leader Required Personal Protective Equipment Entrant log refer to Attendant Tactical Worksheet Entrant medical monitoring log refer to Medical Group Supervisor Tactical Worksheet Primary and Back-up entry teams shall be appropriately equipped for hazards identified: Respiratory: Clothing: SCBA BDU’s Communication: APR SAR(max 300ft) Wildland Turnouts Face to Face Rescue Equipment: Harness Relay Class 3 None Chemical OATH Other Hardwire Anklets Radio(intrinsically safe) Fall Protection Atmospheric monitoring device for each primary and back-up entrant Hot Work Is Hot Work required: Yes No Have safety concerns related to hot work been addressed? Yes No Pre-Entry Confirmations Confirm safety check on all rope rescue systems completed Confirm pre entry medical monitoring completed for primary and back-up teams Confirm safety check on primary and back-up entry team’s safety systems completed Confirm all hazards are abated or within limits Objectives for Entrants Page 2 of 3 Communication Plan Emergency vacate plan July 20, 2012
Fire Department Confined Space Entry Permit Required Signatures All known hazardous conditions have been abated to the best of our abilities; key positions established, appropriately trained and equipped personnel at scene for the operation. Signature Date/Time Incident Commander Safety Officer Assistant Safety Officer/USAR Rescue Group Supervisor Permit Cancellation Rescue Group Supervisor Date: Time: Site responsibility turned over to: Date: Time: After the Entry Confirm post entry medical monitoring completed for primary and back-up teams USAR Company shall contact Cal-OSHA within 8 hours of any confined space incident (510) 794-2521 Collect Tactical Worksheets, ICS forms and any other documentation used. All documentation will be used for the Post Incident Evaluation and shall be kept for a minimum 2 years. Copies of all paperwork are to be forwarded to all participating agencies for documentation. Page 3 of 3 July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Incident # Rigging Team Unit Leader Main Line Attendant Safety Line Attendant Haul Team Leader (Check boxes when completed) Briefing from Rescue Group Supervisor Establish equipment staging area and equipment transportation plan Coordinate with: Rescue Unit Leader Atmospheric Unit Leader TSO Ventilation Unit Leader Recon incident area for good size-up KEEP RIGGING PLAN SIMPLE All rope systems shall comply with industry standards for rescue operations Establish fall protection needs for any positons Establish entry and retrivel system: DCSR wench Rope system Ladder Establish high point if need: Tripod Ground Ladders Aerial Ladder Establish Rescuer Harness needs: Class 3 Anklelets Other Fixed anchor Other Additional staffing needed for hauling equipment / building system? Remember edge protection. Exterior lighting for rescuers. Other equipment; (toolbox, duct tape, etc.) Confirm that all systems have been safety checked by Assistant Safety Officer (TSO) July 20, 2012
Fire Department Confined Space Tactical Worksheet Jurisdiction: Incident # Attendant (Cal OSHA) Primary Entry Team (CalOSHA Entrant) Backup Entry Team (CalOSHA Entrant) 1. 1. 2. 2. (Check boxes when completed) **Attendant must be Confined Space Rescue Operational Certified** Briefing from Rescue Group Supervisor. Establish equipment staging area **All Entrants must be Confined Space Rescue Operational Certified** Confirm pre entry medical monitoring completed for primary and back-up teams Primary and Back-up entry teams shall be appropriately equipped for hazards identified: Respiratory: SCBA APR SAR(max 300ft) None Other PPE: BDU’s Wildland Turnouts Chemical Other Communication: Face to Face Relay OATH Hardwire Radio(intrinsically safe) Rescue Equipment: Harness Class 3 Anklets Fall Protection Other equipment: Atmospheric monitoring device for each primary and back-up entrant Establish fall protection needs for any positons Establish entry and retrivel system: Establish high point if need: CSR wench Tripod Rope system Ground Ladders Establish Rescuer Harness needs: Class 3 Establish victim packaging needs: Skedco Sled Anklelets Ladder Aerial Ladder Other Fixed anchor Other Wristlets Harness Litter Other Establish if intrinsically safe tools and equipment is needed Establish entrant work duration based on environmental conditions Decontamination zone established if needed Final safety check completed on rescue safety systems for entry and back-up teams by Assistant Safety Officer (TSO) July 20, 2012
Fire Department Confined Space Tactical Worksheet Jurisdiction: Time In: Name: Incident # Time Out: Time In: Name: Time Out: July 20, 2012
Fire Department Confined Space Tactical Worksheet Jurisdiction: Incident # July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Incident # Haz-Mat Group Supervisor Atmospheric Monitoring Unit Leader Utility Control Unit Supervisor Decon Unit Leader Technical Reference Unit Leader (Utility Control Unit Leader) Coordinate efforts with Safety Officer and Assistent Safety Officer on scene Identify site supervisor, representative, maintenance, or competent person on scene Name & Title: Cell Phone Number: Name & Title: Cell Phone Number: Identify and secure general utility hazards method / device used: Identify and secure electrical energy hazards method / device used: Identify and secure ignition hazards method / device used: Identify and secure mechanical hazards method / device used: Identify and secure engulfment hazards: liquid, solid, gas, and dust valves secured method / device used: Identify and mitigate environmental hazards: weather, hot, cold, rain Place Sentries when necessary, Identify their location, function, name and agency: Sentry #1: Sentry #2: 1 of 2 July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Incident # (Atmospheric Monitoring Unit Leader ) Briefing with Rescue Group Supervisor and Medical Team Leader Consult facility operators on-site for other types of hazardous materials to be monitored for. Other monitoring devices needed for this operation. YES / NO Correct PPE for air monitoring: SCBA / BDU’s / Turnouts / Chemical Protection Gas Meters for Entry and Backup personnel. TMX412 / BW Micro / BW Max / Other: LEL Instrument(s): TMX412 / BW Micro / BW Max / Other: [ ] continuous, or: O2 Instrument(s): [ ] continuous, or: Toxicity / PPM Instrument(s): [ ] continuous, or: Colorimetric Tubes or other type of monitoring equipment: [ ] continuous, or: Initials: Time Gases monitored Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: Meter: Meter: Meter: Initials: Gases monitored Time Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: 2 of 2 July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Initials: Time Gases monitored Incident # Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: Initials: Gases monitored Time Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: 3 of 2 July 20, 2012
Fire Department Confined Space Entry Permit Tactical Worksheet Jurisdiction: Incident # Utility Control Unit Leader Name: Name: Name: Name: (Check boxes when completed) Receive incident briefing from Rescue Group Supervisor Coordinate efforts with Safety Officer and Technical Safety Officer on scene Identify site supervisor, representative, maintenance, or competent person on scene Name & Title: Cell Phone Number: Name & Title: Cell Phone Number: Name & Title: Cell Phone Number: Identify and secure general utility hazards method / device used: Identify and secure electrical energy hazards method / device used: Identify and secure ignition hazards method / device used: Identify and secure mechanical hazards method / device used: Identify and secure engulfment hazards: liquid, solid, gas, and dust valves secured method / device used: Identify and mitigate environmental hazards: weather, hot, cold, rain Place Sentries when necessary, Identify their location, function, name and agency: Sentry #1: Sentry #2: Sentry #3: Restoration of utilities referred to site supervisor upon closure of the entry permit July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Incident # Atmospheric Monitoring Unit Leader Name: Name: Name: Name: (Check boxes when completed) Briefing with Rescue Group Supervisor and Medical Team Leader Consult facility operators on-site for other types of hazardous materials to be monitored for. Other monitoring devices needed for this operation. YES / NO Correct PPE for air monitoring: SCBA / BDU’s / Turnouts / Chemical Protection Gas Meters for Entry and Backup personnel. TMX412 / BW Micro / BW Max / Other: LEL Instrument(s): TMX412 / BW Micro / BW Max / Other: [ ] continuous, or: O2 Instrument(s): Same as above [ ] continuous, or: Toxicity / PPM Instrument(s): Same as above [ ] continuous, or: Colorimetric Tubes or other type of monitoring equipment: [ ] continuous, or: Initials: Gases monitored Time Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: Meter: Meter: Meter: 1 of 2 July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Incident # RESCUER MEDICAL MONITORING SHEET Name Time Pre Entry Pulse 2of 2 Pre Entry B/P Time Post Entry Pulse Post Entry B/P July 20, 2012 Post Entry Temp. Cleared From rehab Time
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Initials: Time Gases monitored Incident # Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: Initials: Time Gases monitored Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: Initials: Gases monitored Time Top O2 H 2S CO Middle LEL O2 H2S CO Bottom LEL O2 H2S CO Special Notes LEL Meter: Meter: Meter: Meter: Meter: Meter: 2 of 2 July 20, 2012
Fire Department Confined Space Entry Tactical Worksheet Jurisdiction: Incident # Medical Group Supervisor Rescuer Medical Monitoring Unit Leader Treatment Unit Leader (Check boxes when completed) Rescuer Medical Unit Briefing from Rescue Group Supervisor Hazard communication briefing from Technical Safety Officer Establish Rescuer Rehab, consider noise, heat / cold, hydration Establish pre-entry and post-entry medical monitoring (see medical monitoring sheet page 2) Standby ambulance Consider rescuer decontamination Treatment Unit Leader Establish patient treatment area and medical equipment staging Standby ambulance Consider patient decontamination 1of 2 July 20, 2012
Fire Department Confined Space Tactical Worksheet Jurisdiction: Incident # July 20, 2012 (Check boxes when completed) **Attendant must be Confined Space Rescue Operational Certified** Briefing from Rescue Group Supervisor. Establish equipment staging area **All Entrants must be Confined Space Rescue Operational
5.2 Eliminating the need to enter a confined space 9 5.3 Fit for work 9 5.4 Identification of a confined space 9 5.5 Confined space entry process 11 5.6 Confined space entry risk assessment 12 5.7 Preparing a confined space for entry 13 5.8 Establishing access points 16 5.9 Confirming a confined space entry team 17
B. Permit-Required Confined Space Program Departments will identify and classify every confined space as either a Permit-Required Confined Space or, when the confined space does not present a real potential hazard, a Non-Permit Confined Space. When Permit-Required Confined Spaces are identified, department heads and supervisors will also be
4.0 PERMIT REQUIRED CONFINED SPACES . 4.1. Classifications of Confined Spaces . Departments will identify and classify every confined space as a: 1. Permit-required confined space; or . 2. Non-permit confined space: when a confined space does not present a safety hazard or potential/ real atmospheric hazard. 4.2. Program Elements for Permit .
Every confined space is unique, and every confined space will have its own hazards Workers must be trained to enter a confined space. This is an awareness course and does not replace confined space training. Confined space means an enc
Include confined space requirements in contracts and inform contractors of confined space hazards associated with confined space work. 4.3. Entry Supervisor 4.3.1. Obtain a Confined Space Assessment / Permit form (Appendix A) to assess the confined space location. 4.3.2. Complete all sections of the Confined Space Assessment / Permit Form .
b. When is expected to perform work in a UO Confined Space, the Contractor will also follow all required applicable OR-OSHA Confined Space codes. c. Having their own Confined Space Program and enter UO Confined Spaces under their own Permit system. d. Upon request Contractors will be required to provide a copy of their Confined Space Program to .
CONFINED SPACES REQUIREMENTS 1. Confined Space Identification a . The brewery must inventory and evaluate the hazards of each confined space in the workplace. This can be accomplished by listing each confined space, where it is located, how often the space may be entered and the classification of the confined space. b .
Accounting records will be maintained in accordance with ORGANIZATION NAME's fiscal year, ie. January 1-December 31. 2. The double-entry method of bookkeeping and the accrual method of accounting shall be used. 3. ORGANIZATION NAME's computer system will be utilized in maintaining and creating the general ledger, all related journals and financial reports. 4. All revenues, support and expenses .
