NCCU Confined Space Plan

Confined Space Plan Version #1.0

Approved: Click or tap to enter a date. Approved by: NORTH CAROLINA CENTRAL UNIVERSITY • 1801 FAYETTEVILLE STREET • DURHAM, NC 27707 EMAIL [email protected] • TELEPHONE 919-530-7125 https://nccu.edu/administration/administration-and-finance/environmental-health-and-safety NORTH CAROLINA CENTRAL UNIVERSITY IS A CONSTITUENT INSTITUTION OF THE UNIVERSITY OF NORTH CAROLINA

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Contents I. Purpose ................................................................................................................................................................. 2

II. Scope ..................................................................................................................................................................... 2

III. Procedures ........................................................................................................................................................ 2

IV. Responsibilities ................................................................................................................................................. 3

A. Environment, Health and Safety (EHS) ................................................................................................... 3

B. Departments with confined spaces ........................................................................................................... 3

C. Employees..................................................................................................................................................... 3

V. Definition of Terms ............................................................................................................................................ 4

A. Confined Space Definitions ....................................................................................................................... 4

B. Entry Team Definitions .............................................................................................................................. 5

C. Hazard and Control Definitions ................................................................................................................ 6

D. Permit Definitions ....................................................................................................................................... 6

VI. Identification and Re-evaluation of Confined Spaces ................................................................................ 7

VII. Entry Procedures for Non-Permit Spaces ................................................................................................... 8

VIII. Confined Space Entry Plans ...................................................................................................................... 9

IX. Entry Procedures for Permit Space ............................................................................................................. 10

A. Pre-Entry ..................................................................................................................................................... 10

B. Entry ............................................................................................................................................................ 11

C. Post-Entry ................................................................................................................................................... 12

X. Telecommunications Underground Lines ..................................................................................................... 13

XI. Procedures for Joint Permit Required Spaces ........................................................................................... 13

XII. Contractors ..................................................................................................................................................... 14

XIII. Rescue Operations ..................................................................................................................................... 15

XIV. Training Requirements .............................................................................................................................. 15

mailto:[email protected]

https://nccu.edu/administration/administration-and-finance/environmental-health-and-safety



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XV. Program Review ............................................................................................................................................. 16

XVI. Record Retention ....................................................................................................................................... 16

XVII. Compliance and Reporting ....................................................................................................................... 17

XVIII. Appendix A Confined Space Hazard Evaluation Form ...................................................................... 18

XIX. Appendix B Confined Space Entry Permit ............................................................................................ 22

XX. Appendix C Contractor Checklist – Permit Required Confined Spaces ............................................... 24

I. Purpose This Plan fulfills the requirements set forth in Occupational Safety and Health Administration (OSHA) Standard 29 CFR 1910.146, 29 CFR 1910.268, or 29 CFR 1910.269. The North Carolina Central University (NCCU) Confined Space Plan is designed to provide a means to protect employees from hazards associated with entry into confined spaces and to develop procedures by which employees can safely enter spaces. The Plan ensures that identified hazards are eliminated or controlled prior to individuals entering confined spaces. The Confined Space Plan is developed and maintained by the Department of Environment, Health and Safety (EHS).

II. Scope The confined space program applies to all NCCU employees and contractors that are affected by confined spaces on campus including those who make entry or provide support for entries into permit spaces on campus. The program includes entry into non-permit and permit-required confined spaces.

III. Procedures

All spaces owned or operated by NCCU that meet the definition of confined space shall be identified by proper signage and access to such spaces shall be controlled. Employees are prohibited from entering any





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space meeting the definition of confined space, unless a business need is determined to require entry, the employee has received all necessary training prior to entry, and the requirements of this Plan and any departmental policies are strictly followed.

IV. Responsibilities A. Environment, Health and Safety (EHS)

• Administers NCCU Confined Space Plan • Maintains campus-wide list of confined spaces as part of the NCCU Plan • Reviews and approves departmental confined space plans • Provides or oversees required training for the NCCU Confined Space Program • Conducts periodic inspections to verify departmental compliance with the NCCU Confined

Space Plan

B. Departments with confined spaces

• Implement NCCU and Departmental Confined Space Policies with staff • Evaluate departmental needs and equip employees with the materials required to safely

perform confined space entries. • Determine and document by job title employees that may enter permit spaces, or perform

work within non-permit spaces that may cause the space to meet the definition for permit-required confined space during work activities.

• Designate Entry Supervisors, Attendants, and Entrants and ensure they receive required training prior to performing any confined space work

• Develop departmental confined space entry plan using the Confined Space Entry Plan Template. All departmental plans must be approved by EHS and t meet all the requirements of 29 CFR 1910.146, 29 CFR 1910.268, or 29 CFR 1910.269, as applicable.

C. Employees

• Understand and adhere to the requirements of this Plan and departmental entry plans if involved with confined space entries





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• Employees who work around confined spaces must understand that they are not allowed to enter confined spaces without proper training and approval

V. Definition of Terms

A. Confined Space Definitions

1. Confined Space: a space that meets all three of the following conditions: a. Large enough for a person to bodily enter and perform work; b. Has only means of entry/egress that requires a person to enter by a means other than

normal walking, such as crawling, squatting, climbing, bending, or use of devices; and c. Is not designed for people to continually occupy the space.

Examples of confined spaces include but are not limited to tanks, silos, vessels, pits, sewers, pipelines, boilers, utility vaults, tank cars, and other mobile containers. In the US, any pit or trench with a depth equal to or greater than 4 feet is considered a confined space.

2. Non-Permit Space: a confined space that does not contain any actual or potential hazards capable of causing death or serious physical harm.

3. Permit Required Confined Space (Permit Space): a confined space which has one or more of the following characteristics:

a. Hazardous atmosphere - an atmosphere that may expose employees to the risk of death, incapacitation, impairment of the ability to escape unaided from a permit space, injury, or acute illness. Hazardous atmospheres may be created by conditions such as, but not limited to:

i. Flammable gas, vapors, or mists in excess of 10% of the lower flammable limit (LFL) which is the lowest concentration of a substance in air that will sustain combustion when elevated to its ignition temperature.

ii. Airborne combustible dusts at a concentration that meets or exceeds its LFL and/or obscures vision at a distance of five feet or less.

iii. Atmospheric oxygen concentration outside of the acceptable range of 19.5-23.5%



https://unc.policystat.com/policy/5136334/latest/



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iv. Atmospheric concentrations at or above the Permissible Exposure Limit (PEL) of substances identified in Subpart Z of 29 CFR 1910.

v. Any other atmospheric conditions which are immediately dangerous to life and health (IDLH)

1. Poses an immediate or delayed threat to life; 2. Would cause irreversible adverse health effects; and/or 3. Would interfere with an individual’s ability to escape unaided from a permit

space. b. Engulfment - 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.

c. Internal configuration that could trap or asphyxiate an entrant (i.e. inwardly converging walls, sloping floor); and/or

d. Recognized serious safety or health hazard (i.e. radiation, exposed electrical hazards, or asbestos).

B. Entry Team Definitions

1. Entry Supervisor the trained individual with the responsibility to: a. Assure acceptable entry conditions are present b. Issue and terminate entry permits c. Oversee entry operations d. Verify procedures and equipment are in place e. Removes unauthorized individuals

2. Attendant: the trained individual stationed outside the permit space who monitors the authorized entrants and who performs all attendant duties.

a. Monitors entrants throughout the job, entry and exit to ensure their safety b. Monitors atmospheric conditions in the space prior to and during entry c. Controls access to the confined space d. Summons emergency assistance as needed.





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e. Assesses hazards in and around the confined space f. Keeps records of confined space work including atmospheric testing and personnel

entry/exit, etc. 3. Entrant: the trained individual who enters the permit space to perform work.

C. Hazard and Control Definitions

1. Physical Hazard: A factor within the environment that can reasonably be expected to cause personal injury, property damage or both. Examples include noise, mechanical, and electrical hazards.

2. Conditions of Entry: set of conditions that must exist in a permit space to allow employees to safely enter and perform duties within the space.

3. Blanking, Binding: absolute closure of a pipe, line, or duct by fastening a solid plate 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. Double Block and Bleed: the closure of a line, duct, or pipe by closing and locking/tagging out two in-line valves, and opening and locking/tagging out a drain or vent in the line between the two closed valves.

5. Inerting: the displacement of the atmosphere in a permit space by a noncombustible gas to such an extent that the resulting atmosphere is noncombustible, producing an IDLH oxygen-deficient atmosphere.

6. Isolation: the complete removal of a permit space from service and the complete protection of that space from the release of energy or material.

7. 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.

D. Permit Definitions

1. Alternate Entry Procedures: the use of continuous forced air ventilation and atmosphere monitoring in lieu of a permit to enter a permit required confined space that:





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a. Has an actual or potential hazardous atmosphere that can be demonstrably controlled by continuous forced air ventilation alone; and

b. Has no other hazards. 2. Emergency: any occurrence (including the failure of hazard control or monitoring equipment) or

event, internal or external to the permit space, which could endanger entrants. 3. Entry: the action of breaking the plane of an opening of a permit space with any part of the body.

Entry includes all periods of time in which the confined space is occupied. 4. Permit: the written or printed document authorizing entry into a permit space and designating the

requirements for entry. 5. Prohibited Condition: any condition in a permit space that is not allowed by the permit during

the period when entry is authorized. 6. Testing: the process by which the hazards that may confront entrants are identified and evaluated.

This term includes the specification of tests that are to be performed in the permit space.

VI. Identification and Re-evaluation of Confined Spaces

Each department is responsible for identifying each of their spaces which meet the definition of a confined space, designating each as non-permit or permit space, and providing a list of such spaces to EHS using the Confined Space Hazard Evaluation Form (Appendix A). Confined spaces shall be considered hazardous until an evaluation is completed.

Departments shall notify EHS if additional confined spaces are identified, new ones are installed or created, or spaces should be removed or reclassified.

Employees shall be notified of the existence and location of confined spaces by DANGER signage posted at the means of ingress to each identified space.





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Employees shall be notified of the existence and location of permit-required confined spaces by the following signage posted at the means of ingress to each identified permit-required space.

VII. Entry Procedures for Non-Permit Spaces

Prior to each entry into a non-permit space, the designated Entry Supervisor shall review the work to be performed.

1. If the work WILL introduce a hazard into the space that will cause it to meet the definition for permit required confined space, the Entry Supervisor shall:

a. Temporarily reclassify the space as a permit space b. Follow procedures for entry into a permit space c. Upon termination of the permit, re-inspect the space and take actions necessary to remove

the hazards created during the work and reclassify the space as a non-permit space d. Permanently reclassify the space as a permit space if the hazards will remain

i. Document the change on the Confined Space Hazard Evaluation Form and provide a copy to EHS.

2. If the work WILL NOT introduce a hazard, the Entry Supervisor may authorize and facilitate non-permitted entry into the space as follows:





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a. Conduct initial atmospheric testing prior to entry in the order indicated below to ensure that within the space:

i. Oxygen is between 19.5 - 23.5%; ii. Flammable gases are at or below 10% of the lower flammable limit; iii. Carbon monoxide is at or below 25 parts per million parts (ppm); and iv. Hydrogen sulfide is at or below 1 ppm.

b. If more than one air contaminant is observed, EHS must review and determine additive effects prior to entry

c. Ensure continuous atmospheric monitoring throughout the entry. If conditions change, entrant must evacuate the space and reclassify the space as a permit space until the source of the contaminant is identified and eliminated. Initiate a Confined Space Entry Permit (Appendix B) and proceed with entry.

VIII. Confined Space Entry Plans Confined Space Entry Plans are documents which describes specific safety procedures for each department having confined space work areas. Individual plans are to be prepared for each department. By Statute, elements of the Plan must include:

1. The identity of the department and the name of the departmental representative 2. An inventory of all confined spaces under control of the department 3. The departmental criteria for permitting entry into confined spaces. 4. A description of the pre-entry and periodic atmospheric testing required for each category of

space. 5. An inventory of all confined space equipment and its location. 6. A description of required training and qualification of personnel. 7. A description of isolation/lockout/tagout procedures. 8. A description of the entry sequence, to include emergency and rescue procedures.





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IX. Entry Procedures for Permit Space

Employees entering a permit space MAY be both the Entry Supervisor and the Entrant, or the Entry Supervisor and the Attendant. Employees may NOT serve as both an Attendant and an Entrant for a permit space entry.

A. Pre-Entry

The Entry Supervisor will: 1. Review the Confined Space Hazard Evaluation Form for the permit space 2. Initiate the NCCU Confined Space Entry Permit form and perform/ensure completion all

required pre-entry tasks a. Survey permit space without entry and review the work to be performed and identify

existing or potential hazards. b. Ensure that pre-entry and ongoing atmospheric testing is conducted and documented on

permit i. Prior to entry ii. During entry - every 5 minutes for the first 20 minutes, then every 20 minutes

thereafter c. Determine if atmospheric hazards can be eliminated or controlled d. Determine mitigation methods which can be used to eliminate or control physical hazards e. Determine which equipment may be necessary

i. Communication equipment for Attendant to summon rescue ii. Communication equipment if Entrants will be out of voice range with the

Attendant iii. Atmospheric testing equipment iv. Forced air ventilation system v. Personal protective equipment vi. Traffic control equipment vii. Mechanical rescue equipment

1. Body Harness with retrieval line 2. Wristlets if body harnesses are not feasible





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3. Mechanical retrieval devices for vertical entries into spaces deeper than five feet.

3. Determine if other permits are required for work to be conducted in the space 4. Sign and issue the permit, effective upon the date issued upon completion of all pre-entry

activities, and expiring on the date indicated on the permit. 5. The permit shall be posted at the point of entry into the space. 6. Require each authorized employee to review permit and become familiar with the hazards of the

space and acceptable entry conditions.

B. Entry

The Entry Supervisor has overall responsibility for the entry and ensures that the job is performed correctly and safely:

1. Understand the hazards that may be encountered in the space. 2. Know the signs and symptom of exposure to physical and chemical hazards present in the space. 3. Assure team members perform their duties in accordance with the training they have received. 4. Assure that acceptable entry conditions are maintained while the space is occupied. 5. Remove unauthorized persons from the permit space, as needed.

The Attendant’s primary function is to protect the entrants in the confined space:

1. Remain outside the permit space at the opening throughout the entry or until relieved by another authorized Attendant

2. Perform no other duties beyond those designated to Attendant 3. Understand hazards that may be encountered during the entry 4. Maintain accurate count of entrants within and without the space on the permit 5. Perform and document periodic atmospheric monitoring during entry 6. Communicate with entrants by voice or communication equipment periodically to assure that all is

well 7. Order an immediate evacuation of the space:

a. If any sign or symptom of an exposure to a dangerous situation is noted b. Upon becoming aware of the development of a condition out of compliance with the

permit; c. Upon failure of an entrant to answer an attempt at communication; and/or d. If unable to continue as the Attendant





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8. Summon rescue services if needed 9. Performs non-entry rescues 10. Warn unauthorized persons away from the permit space and notify Entry Supervisor if

unauthorized persons refuse to leave

The Entrant’s primary function is to safely perform work in a confined space: 1. Know the hazards that may be encountered during entry, including signs or symptoms and

consequences of exposure 2. Enter the space and perform the assigned work 3. Utilize all equipment required by the permit 4. Maintain communication with Attendant 5. Inspect for unidentified hazards during entry 6. Immediately evacuate the space and alert Attendant if any of the following occurs:

a. Attendant orders an evacuation b. Condition develops which is not in compliance with the permit c. Signs or symptoms of exposure to a dangerous situation occur d. Failure of any required equipment e. Loss of communication with Attendant

C. Post-Entry

If the entry was successfully completed the Attendant will: a. Assure and document that all entrants have exited the space b. Oversee completion of post-entry actions c. Return the permit to the Entry Supervisor for signature and retention

If the space is evacuated prior to completion of work: 1. Attendant terminates the permit, documents reasons for evacuation, and notifies the Entry

Supervisor 2. Entry Supervisor determines if reentry is required to complete work, eliminate a created hazard, or

return the space to normal operation. 1. If reentry is necessary, the reason for the evacuation must be completely investigated and

eliminated or controlled





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i. Issue new permit which includes the elimination or control of the hazard causing the evacuation.

ii. Alternate Entry Procedures and Reclassification to Non-Permit Space shall not be approved.

X. Telecommunications Underground Lines When telecommunication field work is performed on or with underground lines, 29 CFR 1910.268(o) applies to the extent that compliance with its provisions adequately addresses the permit space hazards. Such hazards include: protection from falling or from falling objects; vehicular or pedestrian traffic hazards; unusual water hazards; operations in manholes used jointly by a telecommunication utility and by an electric utility; and atmospheric hazards of manholes and unvented vaults. If a telecommunication underground line poses hazards which are not addressed by 1910.268 (o), then the pertinent provisions of the Permit Required Confined Spaces regulation (29 CFR 1910.146) apply.

XI. Procedures for Joint Permit Required Spaces

There may be situations in which a department must perform work in a confined space controlled by another department. The Entry Supervisor is responsible for coordinating with the NCCU department controlling the space prior to entry. The non-controlling department is prohibited from entering a confined space without approval from the controlling department.

1. Entry Supervisor will ensure that all participants are trained on and conform to any department-specific entry requirements from the controlling department.

2. Upon request, the Entry Supervisor shall provide training documentation for entry participants to the controlling department.

3. Upon completion of the entry, the Entry Supervisor shall immediately meet with the controlling department to provide entity to provide information on:

a. Hazards within the space of which the controlling department was unaware b. Issues encountered during entry procedures including emergencies, evacuations, or other

unexpected events related to the entry





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4. Entry Supervisor shall submit the canceled permit and/or any documentation prepared as a result of entry to the controlling department Program Records Coordinator, who shall retain the document for the required retention period.

XII. Contractors It may be necessary for non-NCCU contractors or companies to enter and work within confined spaces or join NCCU staff within confined spaces on campus. In these instances, NCCU and the contractor or company must coordinate to ensure the safety of all involved. The NCCU department which controls the space must:

1. Apprise the contractor that the space is a confined space and of the hazards within the space; 2. Work with contractor to complete the Contractor Checklist for Permit-Required Spaces (Appendix

C); 3. Require the contractor to control entry into the space by the contractor’s permit system meeting

the requirements of 29 CFR 1910.146 or other applicable standards; 4. Verify that the contractor and their employees have received training that meets the requirements

of 29 CFR 1910.146 or applicable standard; and 5. Require the contractor to eliminate any temporary hazards created by the work, or notify the

NCCU department responsible for the space of any permanent hazards created by the work. 6. Notify any employees who may be near or affected by entry prior to entry being made

The contractor/company is responsible for: 1. Working with NCCU to complete the Contractor Checklist for Permit-Required Spaces (Appendix

C); 2. Providing NCCU with company’s confined space program and procedures 3. Having awareness of NCCU confined space entry plans and procedures 4. Meeting with the responsible NCCU department supervisor after completion of the entry to

discuss new permanent hazards created by the work and/or any unidentified hazards encountered during the entry.

During a joint entry of involving NCCU employees and contracted personnel it is the responsibility of





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both the NCCU Entry Supervisor and the Contractor to: 1. Account for all entrants of both employers during the entry 2. Ensure that the work of one group does not endanger the employees of the second group 3. Verify that a properly trained attendant in place whenever employees of either employer have

entered the space 4. Eliminate temporary hazards and track, report and document new permanent hazards.

XIII. Rescue Operations The Attendant is required to call University Police Department (UPD) Communications Center at 919-530-6106 to make notification of a confined space entry including location of confined space and the anticipated start and completion time for the entry. The UPD Communications Center then notifies the Durham Emergency Communications Center prior to the entry and once the entry is completed.

If an emergency arises that requires a rescue team, the Attendant will call the Durham Emergency Communications Center by dialing 911 and request the Durham Fire Department respond to a confined space emergency.

Durham County Fire Department is to be allowed access to all permit spaces from which rescue may be necessary so that the rescue service can develop appropriate rescue plans and practice rescue operations. Durham Fire Department is responsible for providing documentation of this training to EHS.

XIV. Training Requirements The following training courses are required for all employees who work in departments which require a written Confined Space Entry Program.

• Confined Space Entry Procedures – All Entrants and Attendants • Confined Space Training for Entry Supervisors • Confined Space Training for Program Records Coordinators • Confined Space Hazards Awareness - All other employees not covered in above training.

Training shall be provided:





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1. Prior to assignment or authorization of duties within permit spaces and annually thereafter; 2. Within three months after revisions of this program or departmental procedures.

Assignment or authorization for permit space entry shall be suspended until training is completed;

3. Whenever the supervisor becomes aware that an employee is deviating from the procedures of this Plan. Assignment or authorization for permit space entry shall be suspended until training is completed; and

Training shall be provided by EHS or their designee. Training records shall be maintained by the Program Records Coordinator and EHS.

XV. Program Review EHS is responsible for working with each department to review the effectiveness of the Program annually. This will be done in conjunction with each department’s Program Records Coordinator and Entry Supervisor using canceled permits and other documentation from the preceding twelve months, Entry Supervisor comments, and other available information. Program Records Coordinators and Entry Supervisors may make recommendations to EHS at any time to make changes in procedures to address and correct weaknesses in the Plan. EHS shall view and initiate changes necessary to address confirmed weaknesses. Program Records Coordinators and Entry Supervisors are responsible for reviewing the departmental specific procedures annually and making any changes necessary to address and correct weaknesses or deficiencies. New or updated procedures must be approved by EHS prior to being implemented.

XVI. Record Retention

1. Canceled Permits and other documentation shall be retained by the departmental Program Records Coordinator not less than one year following the date of entry and at least for the duration between annual reviews.

2. After the annual review, EHS retains cancelled permits as employee exposure records. 3. Employee training records shall be retained by EHS for the length of employment.





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XVII. Compliance and Reporting

Anyone with concerns confined space areas or work protocols are encouraged to reach out to EHS at 919-530-7125 or [email protected]. The investigation of these concerns is handled in a confidential manner, if the employee wishes.






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XVIII. Appendix A Confined Space Hazard Evaluation Form

CONFINED SPACE HAZARD EVALUATION

FORM

Name/Title of Evaluator: Click or tap here to enter text. Date of evaluation: Click or tap to enter a date.

Location of Space (include Building # of closest building) Click or tap here to enter text.

Description of Space, including dimensions Click or tap here to enter text.

Number of entrances to space: Click or tap here to enter text.

Reasons for entering space & typical activities Click or tap here to enter text.

Who usually enters space? ☐ Maintenance ☐ Production ☐ Contractors ☐ Other; Specify Click or tap here to enter text. Frequency of entry Choose an item. Number of entry points Click or tap here to enter

text. External connections to space Click or tap here to enter text. Comments: Click or tap here to enter text.

Confined Space if 1 – 3 below are ALL “Yes” Permit Required Confined Space if ANY below are

“Yes” 1. Is the space large enough

and shaped so an employee can enter and work?

Yes ☐

No ☐

Potential hazardous atmosphere? (See A) Yes ☐

No ☐

2. Limited or restricted entry/exit?

Yes ☐

No ☐

Potential for engulfment? (See B) Yes ☐

No ☐





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3. Not designed for continuous human occupancy?

Yes ☐

No ☐

Internal configuration hazards? (See C) Yes ☐

No ☐

Other serious safety hazard? (See D-G) Yes ☐

No ☐

A. Does the space have or is there the potential for: • Hazardous atmosphere (oxygen deficient, flammable vapors, toxic gases or dusts, etc.) ☐ Y ☐

N • Pipes, ducts, vents or other entry points for potentially hazardous substances ☐ Y ☐ N • Use of volatile chemicals ☐ Y ☐ N • Painting or other work that could create a breathing hazard ☐ Y ☐ N

Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. B. Does the space contain a material with the potential for engulfment of a worker (grain, sand or

water)? ☐ Y ☐ N

Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. C. Does the space have an internal configuration that could trap or asphyxiate an entrant (i.e. inwardly

converging walls, sloping floor); and/or recognized serious safety or health hazard (i.e. radiation, exposed electrical hazards, or asbestos)? ☐ Y ☐ N

Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. D. Potential Energy

• Electrical ☐ Y ☐ N • Hydraulic ☐ Y ☐ N • Pneumatic ☐ Y ☐ N • Mechanical ☐ Y ☐ N • Fire control system ☐ Y ☐ N • Steam ☐ Y ☐ N





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Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. E. Environment in the Space

• Slippery Surface ☐ Y ☐ N • Ambient temperature high or low ☐ Y ☐ N • Surface temperatures high or low ☐ Y ☐ N • Noise ☐ Y ☐ N

Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. F. Other Hazards

• Animals ☐ Y ☐ N • Insects ☐ Y ☐ N • Biological organisms ☐ Y ☐ N • Radiation ☐ Y ☐ N

Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. G. External Hazards that could impact safety in space

• Traffic ☐ Y ☐ N • Machinery ☐ Y ☐ N • Equipment ☐ Y ☐ N • Processes ☐ Y ☐ N • Terrain ☐ Y ☐ N

Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text. H. Will welding, cutting, torch work, or other hot work be performed? ☐ Y ☐ N





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Describe specific hazard: Click or tap here to enter text. Comments: Click or tap here to enter text.

Summary of Findings Type of Space Select (only one)

“NO” to questions A through E Non-Permit Required Confined Space ☐ “YES” to question A Permit Space

• General • Hazardous

☐ ☐

“YES” to question B, C or D, Permit Space – General ( if hazards can be controlled)

☐

“YES” to question H Permit Space with Hot Work – must also issue a Hot Work Safety Permit

☐

If hazard evaluation determines this to be a PRCS, is space posted with signs indicating a PRCS? Eligible for Alternate Procedure? (if Hazardous Atmosphere is ONLY hazard)

Yes ☐ No ☐ Eligible for Reclassification (If NO hazardous atmosphere and ALL hazards can be eliminated before entry)

Yes ☐

No ☐

Comments: Click or tap here to enter text. Signature:





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XIX. Appendix B Confined Space Entry Permit NORTH CAROLINA CENTRAL UNIVERSITY

CONFINED SPACE ENTRY PERMIT Valid for maximum of one eight (8) hour shift

MUST be posted at work site

Type of Entry Permit: ☐General ☐Hazardous* ☐ Hot Work** Name of Entry Supervisor:Click or tap here to enter text. Date:Click or tap to enter a date.

Work to be performed:Click or tap here to enter text. Duration of work (hours): Click or tap here to enter text. Location of Permitted Confined Space: Click or tap here to enter text. Pre-Entry Briefing Conducted by: Click or tap here to enter text. Authorized Entrant(s) : Click or tap here to enter text. Attendant name: Click or tap here to enter text. Not required ☐ Specific hazards to be encountered (see Hazard Evaluation Form): Click or tap here to enter text. Hazard control methods to be used: Click or tap here to enter text. Required equipment to be used: (inspected and operational)

Personal Protective Equipment ☐ Type: Click or tap here to enter text.

Air monitoring ☐ Retrieval / Rescue ☐ Communication* ☐ Purge / Ventilation ☐*Attendant must have phone to summon rescue or emergency services by dialing 911

Tools (electrical equipment, non-sparking tools, etc.) ☐ List type: Click or tap here to enter text.

MONITORING RESULTS Performed by: Click or tap here to enter text. Date/Time Location O2 19.5–23.5% LEL<10% H2S <10 ppm CO <35 ppm Other

Acceptable levels/ranges shown in green Attendant confirms all Entrants have exited the confined space (initials):





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This confined space has been evaluated in accordance with the NCCU confined space entry procedures. All persons participating in this confined space entry have been trained in confined space entry procedures. The creation or discovery of any work induced hazards or other unforeseen, actual, apparent or potential hazards, requires the space be re-evaluated, additional precautions taken, and a new permit issued, if appropriate.

Entry Supervisor Signature (Issued): Date and Time:

Entry Supervisor Signature (Closed): Date and Time:

EHS Authorization (Hazardous Entry Only): Date and Time:





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XX. Appendix C Contractor Checklist – Permit Required Confined Spaces Contractor Checklist

Permit-Required Confined Spaces In accordance with the requirements of the North Carolina Central University (NCCU) Confined Space Program, this information is used to document that contractors/companies working on NCCU premises are provided with the necessary information to ensure that all precautions are taken to protect employees should it be necessary for them to enter identified permit-required confined spaces while working on NCCU premises. NCCU Coordinating Department: Click or tap here to enter text. NCCU Coordinator (name and title): Click or tap here to enter text. Contractor/Company: Click or tap here to enter text. Contractor/Company Coordinator (name/title): Click or tap here to enter text. If NCCU employees will not be involved in entry into or work near permit-spaces while work is being performed by the contractor/company, the NCCU Coordinator is responsible for:

Task Completed Apprise the contractor of permit-required confined space and the hazards within ☐ Require the contractor to control entry into the space by the contractor’s permit system meeting the requirements of 29 CFR 1910.146

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Verify that the contractor and their employees have received training that meets the requirements of 29 CFR 1910.146

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Require the contractor to eliminate any temporary hazards created by the work or notify NCCU of any permanent hazards created by the work

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Notify NCCU Department responsible for confined space that work is occurring to allow NCCU employees near or affected by the entry

If NCCU employees will be involved with entry into or near the permit space, these additional tasks are required:

Task Completed





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Department responsible for confined space will assign an Entry Supervisor to coordinate with contractor and monitor activities. List Entry Supervisor Name: Click or tap here to enter text.

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Determine which confined space entry program will be used for entry into permit-spaces ☐ NCCU ☐ Contractor/Company

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Entry Supervisors ensure: a. All entrants of both employers can be accounted for during the entry; b. The work of one employer does not endanger the employees of the second employer; c. There is a properly trained attendant in place whenever employees of either employer have

entered the space; and d. Temporary hazards are eliminated, and the supervisors are apprised of new permanent hazards

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Post-entry requirement

Task Completed Provide a post-entry debrief to NCCU Coordinator or Entry Supervisor which covers at minimum:

a. Was the confined space program adequate? ☐ Yes ☐ No If no, what deficiencies were noted? Click or tap here to enter text.

b. Were any new, permanent hazards created by the work? ☐ Yes ☐ No c. Were any unidentified hazards encountered during entry? ☐ Yes ☐ No

If yes, list circumstances and actions to be taken to prevent reoccurrence. Click or tap here to enter text.

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North Carolina Central University Department: Click or tap here to enter text. Date: Click or tap to enter a date. Coordinator/Supervisor Name: Click or tap here to enter text. Title: Click or tap here to enter text. __________________________________________ Signature Contractor/Company Name: Date: Click or tap to enter a date.





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Representative Name: Click or tap here to enter text. Title: Click or tap here to enter text. __________________________________________ Signature

COMPLETED FORM IS RETAINED BY DEPARTMENT PROGRAM RECORDS COORDINATOR



NCCU Confined Space Plan

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