Permit Request • CampusOptics

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

The Ohio State University Confined Space Entry Permit

Confined Space Entry Date* Required

Campus:* Required

Confined Space (Building or Location) * Required

Section I: Hazard Identification

Can the space be entered?* Required

Does the space have limited or restricted means of entry and exit?* Required

Is the space designed for continuous human occupancy?* Required

Does the space meet the criteria of a confined space?* Required

Confined Space Supplemental Information

Confined Space Name and/or Number (Asset Number):

Purpose of Entry:

Are all personnel confined space trained/authorized by Ohio State EHS?

Are the appropriate confined space signs posted at the entrance?* Required

Is the Entry Location Barricaded?* Required

Is the air monitor current on its calibration and bump test?* Required

Competent Person will perform Pre-Entry Atmospheric Sampling?* Required

Confined Space will be continuously air monitored?* Required

Section II Additional Hazards

Are there a potential for any of the following atmospheric hazards (actual or potential) in the space?

Are there a potential for any of the following biological hazards (actual or potential) in the space?

Sewage
Infectious Agents
Molds or Fungi
Other

Are there a potential for any of the following configuration hazards (actual or potential) in the space?

Section II Additional Hazards -Continued

Are ALL of the selected hazards above either eliminated isolated or controlled?

How are these hazards being eliminated isolated or controlled?* Required

Are Hazardous Energy Sources Present?* Required

How are these hazards being eliminated and or isolated?* Required

Is Hot Work being performed? * Required

Are the hot work hazards controlled to eliminate any atmospheric or flammable hazards* Required

How are these hot work hazard being controlled:* Required

Is the air monitor current on its calibration and bump test?* Required

Name of the competent person performing initial air monitoring:* Required

Time of the initial air sampling results: (AM or PM)* Required

Initial Air Sampling Results Taken From Confined Space

What was the Oxygen (O2) measurement? Acceptable levels (>19.5% to 23.5%)* Required

What was the combustible gas measurement (LEL)? Acceptable levels (<10% LEL)* Required

What was the Carbon Monoxide (CO) measurment? Acceptable Levels (<35ppm)* Required

What was the Hydrogen Sulfide (H2S) measurment? Acceptable Levels (<10ppm)* Required

Based on your answers above this is NOT considered a confirmed space.

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files