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

Basic Information

Location and Description of Confined Space* Required

Purpose of Entry* Required

Entry Supervisor* Required

Entrants* Required

Attendants* Required

EH&S Pre-Entry Authorization

If Other, Please Describe* Required

Safety Precautions

Self-Contained Breathing Apparatus* Required

Respirator-other type* Required

Fire-Retardant Clothing* Required

Protective Gloves* Required

Ventilation* Required

Rescue* Required

Lifelines* Required

Lockout/Tagout* Required

Fire Extinguishers* Required

Ground Fault Interrupter* Required

Barricade Job Area* Required

Signs Posted* Required

Clearances Secured* Required

Lighting* Required

Confined Space Meter Bump Test Prior To Entry* Required

Communication Procedures* Required

Emergency Rescue Procedures* Required

Add Supporting Documents

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

Files

Confined Space Permit Request