CONFINED SPACE ENTRY PERMIT 封闭空间进入许可Because the confined space entry involves high risk, so pls think about if you have other way to complete this task. 因为封闭空间进入作业风险很大，请考虑其必要性Serial No 编号______________GENERAL INFORMATION 一般信息Space to be entered 封闭空间位置:____________________________________ ________________________________________________________________ ________________________________________________________________Location/Building 封闭空间名称: ____________________________________________________________________________________________________PURPOSE OF ENTRY 作业目的:____________________________________AUTHORIZED DURATION OF PERMIT 授权时间: DATE 日期:__________________________________________________________TIME 时间:________________________to 到________________________________Craft/Department 部门: _________________________________________________Superintendent 主管:____________________________________________________PERMIT SPACE HAZARDS 封闭空间危害 (INDICATE SPECIFIC HAZARDS WITH INITIALS 指出具体的危害)_______ Oxygen (less than 19.5% or greater than 23.5%)氧气（19.5％～23.5％） ______ Materials harmful to skin 伤害皮肤_______ Flammable gases or vapors (greater than 10% of LEL)可燃气或蒸汽（大于 10％LEL） ______ High temperature 高温_______ Toxic gases or vapors (greater than PEL/TLV)毒性气体（大于 PEL/TLV） ______ Mechanical hazards 机械危害_______ OTHER: Complete TSTI/ JSA form & attach 其它：执行 TSTI/JSA EQUIPMENT REQUIRED FOR ENTRY AND WORK 封闭空间作业必要设备Specify as required 详细要求:Personal Protective Equipment 个人劳动保护用品:Atmosphere Testing/Monitoring 环境测试/监控: 02 Monitor 氧含量测试 Sample Tube (s)取样分析:_____________________________________Communication 沟通:_______________________________________________Rescue Equipment 救援设备:Full Body Harness 全身式安全带 Mechanical Hoist 机械提升装置Other 其它: ______________________________________________________________________________________________________________________________________________________________________________________PREPARATION FOR ENTRY 准备进入Check after steps have been taken 检查步骤.Isolation Methods 隔离措施:Personal Awareness 个人须知:Pre-entry briefing on specific hazards and control methods 进入前指导具体的危害和控制措施.Notify contractors of permit and hazard conditions通知承包商许可证和危害条件.Emergency Notification 应急通知: ________________________________________________________________________________________________________________________________Additional Permits: (required and/or attached)其他附加许可证（要求和附件） Hot Work 动火作业 Vehicle Entry 车辆进入 Other 其它________________________________________________Record monitoring results 测试结果 every 每 _____ hours 小时 for LEL/02可燃气/氧气 **List Pre-entry Temperature 准备进入前温度列表TESTING 测试Acceptable Conditions 允许条件Result/Time结果/时间Result/Time结果/时间Result/Time结果/时间Result/Time结果/时间Result/Time结果/时间Result/Time结果/时间Result/Time结果/时间Oxygen – mi 氧气19.5%-23.5%Flammability 可燃气0%Benzene 苯1 PPMCO 一...
