2-2026007 Exhibit B - Confined Space Entry Permit.pdf

This is a Confined Space Entry Permit form used by the Waukesha County Department of Public Works, Facilities Management Division and Parks & Land Use Department in Wisconsin for plumbing services work. The permit establishes procedures and safety protocols for workers entering confined spaces during the execution of plumbing maintenance and repair work across various county buildings. The form requires documentation of the confined space location, hazard identification, atmospheric testing results, rescue equipment availability, and authorized entrant information. All entries must be completed prior to any worker accessing a confined space, and the permit must remain posted at the work site throughout the duration of the confined space entry operation.

The permit form includes sections for atmospheric monitoring data, personal protective equipment requirements, ventilation specifications, and emergency contact information. It mandates that a trained attendant remain outside the confined space during all work activities and requires certification that all required safety equipment has been inspected and is operational. The form serves as documentation of compliance with occupational safety standards and must be signed by both the authorized entrant and the competent person authorizing the work. This administrative control measure is essential for contractor compliance when performing plumbing services on county property and protects workers from hazardous conditions inherent in confined space work environments.