Confined Space Notification Form

Confined Space Notification Form

In accordance with 29 CFR OSHA 1910.146 – Permit Required Confined Spaces the Columbia Fire Department urges those making entry into a permit required confined space to develop and implement procedures for summoning rescue and emergency services, for rescuing entrants from permit spaces, for providing necessary emergency services to rescued employees, and for preventing unauthorized personnel from attempting a rescue. The employer should meet with the prospective rescue service to facilitate the evaluations required by §1910.146(k)(1)(i) and §1910.146(k)(1)(ii). At a minimum, if an off-site rescue service is being considered, the employer must contact the service to plan and coordinate the evaluations required by the standard. Merely posting the service's number or planning to rely on the 911 emergency phone number to obtain these services at the time of a permit space emergency WOULD NOT comply with paragraph (k)(1) of the standard.
  • Ex: vault on back of building, vessel on first floor of processing area, etc.
  • If scheduled work is for multiple days a new form is required for each day of entry.
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  • Space Configuration

    Must choose one.
    Must choose one.
    Must choose one.
    Select all that apply.
  • Any pertinent information specific to this entry that was not covered on this form, please submit here.