SOP 20.pdf

Chillicothe VA Medical Center Chillicothe, Ohio 45601

Signatory Authority:

Confined Space Entry

SOP 20

Service Line(s):

Facilities Management Service

Effective Date:

Chief, Facilities Management Service

Responsible Owner:

Facilities Management Service (138)

1. PURPOSE AND AUTHORITY

December 12, 2022

Recertification Date:

December 12, 2027

a. To establish guidelines and procedures for working in confined spaces and to provide maximum safety protection for employees and contractors who are performing work in confined spaces.

2. PROCEDURES

a. When entry to a confined space is necessary, the following procedures are followed on a daily basis:

(1) The area is inspected by the work supervisor and the OSH Manager or Industrial Hygienist to determine potential hazards, isolation requirements, types of equipment to be used, number of employees required to enter the space and standby personnel required.

(2) The equipment or area is isolated and allowed to ventilate. Confined entry points are posted with Danger, Do Not Enter signage, until such time as requirements have been met.

(3) The Chief, Engineering Section, or designee, issues the Confined Space Entry Permit, Appendix A. The OSH Manager and Fire Department are notified of the proposed entry permit.

Emergency standby equipment is available at the location of the confined space.

(4) The OSH Manager or Industrial Hygienist conduct atmospheric testing and inspect the job site for general safety, isolation, and standby equipment. Prior to entry, the OSH Manager or Industrial Hygienist completes and signs the Confined Space Pre-Entry Checklist, Appendix B, and documents test results.

(5) Each point of entry must have a completed and signed entry permit posted.

(6) At the conclusion of the workday, the entry permit is removed and Danger, Do Not Enter signage is posted.

(7) Entry to a confined space is not permitted until it has been properly prepared, hazards have been identified, standby equipment has been placed on site, and an entry permit has been completed and posted.

(8) The entry permit details the requirements for entry into the confined space.

December 12, 2022 SOP 20

(9) Prior to entering the confined space, each employee reviews the entry permit for specific requirements, reviews emergency procedures, and inspects the confined space for location of entry and exit points.

(10) Retesting of the atmospheric conditions is completed at lunch break or a four-hour interval.

(11) Every confined space is considered immediately dangerous to life and health until it is tested and proven otherwise.

(12) No compressed gas cylinders are permitted inside of the confined space.

(13) Portable electrical tools, equipment, and lighting are powered through a ground fault circuit interrupter.

b. Entry attendants assigned to remain outside of the confined space are equipped with radios, harness, and lifeline. Entry attendants:

(1) Maintain visual or verbal contact with those in the confined space at all times.

(2) Maintain safety lines, if in use.

(3) Summon rescue personnel, if necessary

(4) Summon a supervisor if entry is made in violation of this policy.

(5) Review the conditions for entry into the space as indicated on the Confined Space Entry Permit, Appendix A.

(6) Do not enter or leave the confined space at any time, unless relieved of standby duties.

(7) Continuously maintain an accurate count of authorized entrants in the permit space.

(8) During an emergency situation, make rescue attempts using lifelines from outside the confined space while awaiting the arrival of rescue personnel.

(9) Remain aware of possible behavioral effects of hazard exposure in authorized entrants.

c. Fire Department personnel accomplish rescue of persons from a confined space Emergency rescue personnel are trained in rescue techniques, self-contained breathing apparatus (SCBA) use, use of rescue equipment, and the procedures contained in this policy. Emergency rescue personnel are utilized as entry attendants for confined spaces that can present special hazards, as determined by the supervisor and/or safety representative. Rescue equipment may include:

(1) Harness.

(2) Lifeline.

(3) SCBA.

(4) Stokes litter.

(5) Tripod retrieval system.

(6) Standard firefighter clothing and personnel protective equipment.

d. Isolating equipment for entry is accomplished by blinding or air gapping lines to and from the equipment. Small, screwed lines are disconnected and plugged. Isolation is made as close in proximity as possible to the equipment to be entered.

(1) Double blocks and bleeders are not permitted as a substitute for blinding, except when approved by the OSH Manager or Industrial Hygienist.

(2) Where several pieces of equipment are isolated as a unit, each piece of interconnected equipment is open to the atmosphere and made safe for entry.

(3) Equipment entered is electrically isolated in accordance with Engineering Section SOP 30, Control of Hazardous Energy (Lockout/Tagout). Tagging without locking out equipment is not sufficient for confined space entry.

(4) A record is maintained of blinds, plugs and/or other types of isolation for each entry. Records are used to validate the removal of any type of isolation device. Removing one point of isolation voids the entry permit.

e. Authorized entrants communicate with the attendant, as necessary, to enable the attendant to monitor entrant status and to alert entrants should the need to evacuate the space arise.

3. ASSIGNMENT OF RESPONSIBILITIES

a. The Chief, Facilities Management Service (FMS), is responsible for ensuring projects, maintenance and repairs in confined spaces utilize only authorized entrants under a properly executed Confined Space Entry Permit, Appendix A, and ensures permit spaces are identified.

a. The Safety and Occupational Health (OSH) Manager, Industrial Hygienist, or designee, provides technical guidance to affected employees for entry into a confined space. Additional responsibilities include:

(1) Inspecting the confined space prior to entry for compliance to this policy.

(2) Performing atmospheric testing and completing the Confined Space Pre-Entry Checklist, Appendix B.

(3) Providing confined space entry training.

b. The Fire Department provides rescue services and emergency rescue personnel to be utilized as entry attendants for confined spaces that can present special hazards. Emergency rescue personnel are responsible for completing annual confined space rescue training.

c. The entry supervisor is knowledgeable of the hazards associated with permit required spaces, including information on the mode, signs or symptoms, and consequences of the exposure. Additional responsibilities include:

(1) Determining when responsibility for a permit space entry operation is transferred and, at intervals dictated by the hazards and operations performed within the space, that entry operations remain consistent with terms of the entry permit and that acceptable entry conditions are maintained.

(2) Ensuring that equipment needed for safe entry into any permit required space is available and in proper working order.

(3) Verifying that rescue services are available and that the means for summoning rescue services are operable.

(4) Removing unauthorized individuals who enter or attempt to enter the permit space during entry operations.

(5) Verifying, by checking that appropriate entries are made on the permit, that tests specified by the permit are conducted and that procedures and equipment specified by the permit are in place prior to signing and approving the permit and allowing entry to begin.

(6) Terminating the entry and cancelling the permit following task completion.

d. Entry attendants are knowledgeable of permit space hazards, prohibited conditions, the role to remain outside and in communication with entrants, prevention of unauthorized entry, procedures to request rescue and emergency services, and performance of non-primary duty is to monitor and protect authorized entrants. Entry attendants are trained on the procedures contained in this policy and are knowledgeable of the hazards associated with permit required spaces, including information on the mode, signs or symptoms, and consequences of the exposure.

e. Authorized entrants are trained on the procedures contained in this policy and are knowledgeable of the hazards associated with permit required spaces, including information on the mode, signs or symptoms, and consequences of the exposure. Additional responsibilities include:

(1) Maintaining proficiency in dealing with the hazards of permit required spaces, proper equipment use, communications systems, acceptable entry and prohibited conditions, immediate evacuation conditions, and safe work task performance.

(2) Alerting the attendant when a prohibited condition is detected wo when any warning sign or symptom of exposure to a dangerous situation is recognized.

(3) Exiting the permit space as quickly as possible when:

I. A prohibited condition is detected.

II. An order to evacuate is given by the attendant or the entry supervisor.

III. An evacuation alarm is activated.

IV. Any warning sign or symptom of exposure to a dangerous situation is recognized.

f. Contractors performing work is a confined space at this facility are required to adhere to the requirements of this SOP.

4. DEFINITIONS

a. Confined Space: An enclosed space that is large enough and so configured that an employee can bodily enter and perform assigned work, has limited or restricted means for entry or exit, and is not designed for continuous employee occupancy. Examples of confined spaces are listed in Appendix C, Confined Spaces, and include storage pits, vats, tanks, boilers, ventilation/exhaust ducts, sewers, tunnels, manholes, underground utility vaults or pipelines, and excavations.

b. Permit Required Confined Space:

(1) Contains or has a known potential to contain a hazardous atmosphere.

(2) Contains material with the potential for engulfing of an entrant.

(3) Has internal configurations that could trap or asphyxiate an entrant.

(4) Contains any other recognized serious safety or health hazards.

c. Hazardous Environment/Atmosphere: An atmosphere presenting a potential for death, disablement, injury, or acute illness from one (1) or more of the following causes:

(1) Less than 19.5 percent or more than 23.5 percent oxygen.

(2) A flammable gas or vapor in excess of 10 percent of its lower explosive limit (LEL).

(3) An airborne combustible dust at a concentration that obscures vision at a distance of five (5) feet or less.

(4) An atmospheric concentration that exceeds the listed numerical value of any toxic, corrosive, or asphyxiant substance listed in the Threshold Limit Value (TLV) book by the American Conference of Governmental Industrial Hygienists (ACGIH) or the permissible exposure limit (PEL) that is reasonably expected to be present.

(5) A biological or radiological hazard or one that is otherwise known to present a safety or acute health hazard.

(6) Any condition immediately dangerous to life or health.

d. Entrapment: An area that contains material with the potential to engulf the entrance.

e. Lower Explosive Limit (LEL): The lowest concentration of gas or vapor (percent by volume in air) that will burn or explode if an ignition source is present.

f. Isolation: A process to remove a confined space from service and to completely protect against the inadvertent release of material by the following:

(1) Blanking: The absolute closure of a pipe, line or duct by fastening a solid plate or cap across the pipe, line or duct capable of withstanding the maximum upstream pressure.

(2) Double Block and Bleed: Isolating a confined space from a line, duct or pipe by locking and tagging two (2) closed in-line valves, and locking and tagging open a drain or bleed in the line between the two (2) closed valves to the outside atmosphere.

(3) Lockout: The placement of a locking device on an energy-isolating device, in accordance with an established procedure, to ensure that the energy-isolating device and the machine or equipment being controlled cannot be operated until the locking device is removed. Lockout devices require a tagging device to be used in conjunction with the locking device unless specifically not required by a documented lockout/tagout procedure. Refer to Engineering Section Standard Operating Procedures (SOP) 30, control of Hazardous Energy (Lockout/Tagout).

(4) Mechanical Isolation: Isolation achieved by disconnecting linkages or removing drive belts or chains of moving parts. Equipment with moving mechanical parts is also blocked in such a manner that there can be no accidental rotation.

g. Permissible Exposure Limit (PEL): Regulatory limits on the amount or concentration of a substance in the air, as established by the Occupational Safety and Health Administration (OSHA).

h. Purging and Ventilation Purging: The method by which gases, vapors or other airborne impurities are displaced from a confined space to adjust the atmosphere to acceptable standards.

This is accomplished by using fluids or vapors (gas, water, steam and/or cleaning solutions) or by forced air ventilation.

i. Ventilation: The movement or circulation of fresh air to keep hazards away after purging.

Ventilation is used after entry is made into a space to:

(1) Supply continuous fresh air for entrants inside to breathe.

(2) Remove potentially hazardous conditions before they become hazardous.

(3) Supply cool air for comfort.

5. REFERENCES

a. SOP NUMBER 30, Control of Hazardous Energy (Lockout/Tagout), dated December 12, 2022.

6. REVIEW

This SOP will be reviewed every five (5) years, at minimum for recertification or when there are necessary changes to the document or governing documents (for example, national policy or a health care accreditation body mandate), and any regulatory requirement for more frequent review.

7. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of December 2027. In the event of contradiction with national policy, the national policy supersedes and controls.

8. SIGNATORY AUTHORITY

Ryan Jeter, PE, PS, CHFM Chief, Facilities Management Service Date Approved:

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: Facilities Management Service (138), Safety and Occupational Health Manager (001S), Industrial Hygienist (001S), Fire Department (07F). SOPs are available at:

https://dvagov.sharepoint.com/sites/vhachidcs/default.aspx.

Appendix A

CONFINED SPACE ENTRY PERMIT

RESCUE/FIRE: Ext. 444 SAFETY: Ext. 17952/17153

PERMIT VALIDATION PERIOD: Date Time From To

LOCATION OF WORK

DESCRIPTION OF WORK

REQUIREMENT CHECK LIST: RECORDKEEPING:

INITIAL EACH TEST COMPLETED AND INDICATE TEST TIME (After initial entry, retest is required after lunch or at 4-hour intervals):

TEST PEL COMPLETION TIME INITIALS RETEST TIME INITIALS

OXYGEN DEFICIENCY (O2) 19.5% - 23%

FLAMMABLE VAPORS (LEL) Any % < 10

CARBON MONOXIDE (CO) 35 PPM

HYDROGEN SULFIDE (H2S) 10 PPM

OTHER TOXINS (specify)

LOCKOUT/TAGOUT

BLINDING/ISOLATION

OTHER

NOTE: STANDBY EQUIPMENT IS REQUIRED AT ALL CONFINED SPACE ENTRIES. STANDBY PERSON IS REQUIRED AT ALL CONFINED SPACE ENTRIES. RESCUE HARNESS MUST BE WORN BY ALL PERSONS ENTERING A CONFINED SPACE.

SIGNATURES:

CHIEF, FACILITIES MANAGEMENT SERVICE (verbal contact after hours)

SUPERVISOR (or designee) IN CHARGE

TESTING OPERATOR

ENTRY CANNOT BE MADE UNTIL ALL CONDITIONS ARE MET AND ALL SIGNATURES OBTAINED.

OP-516 (April 2013)

ITEM YES NO CONDITION

MET

ISOLATION/BLINDING

ELECTRICAL

LOCK/TAGOUT

VENTILATION

MECHANICAL

RESCUE EQUIPMENT

HOT WORK PERMIT

CONTINUOUS

MONITORING

SPECIAL CLOTHING

RESPIRATORS

CLEANING/SLUDGE

REMOVAL

MECHANICAL ISOLATION

OTHER

LIFELINES

FULL BODY HARNESS

RETRIEVAL DEVICE

FIRE EXTINGUISHER

COMMUNICATION

SPECIAL LIGHTING

EMPLOYEES ENTERING AREA:

a.

b.

c.

SUPERVISOR IN CHARGE:

STANDBY PERSON:

HAZARDOUS CONTANIMATES FOUND:

b.

c.

COMMUNICATION PROCEDURES (to be used by attendants and entrants):

Appendix B

Confined Space Pre-Entry Checklist

A confined space is either entered through an opening other than a door (such as manhole or side port) or requires the use of a ladder or rungs to reach the working level.

Test results must be satisfactory. This checklist must be completed whenever the job site meets this criteria. See Engineering Services SOP No. 20, Attachment C, Confined Space Listing.

Yes No

1. Did your survey of the surrounding area show it to ( ) ( ) be free of hazards such as drifting vapors from tanks, piping, or sewers?

2. Does your knowledge of industrial or other discharges ( ) ( ) indicate this area is likely to remain free of dangerous air contaminants while occupied?

3. Are you certified in operation of the gas monitor to ( ) ( ) be used?

4. Has a gas monitor functional test (Bump Test) been ( ) ( ) performed this shift on the gas monitor to be used?

5. Did you test the atmosphere of the confined space ( ) ( ) prior to entry?

6. Did the atmosphere check as acceptable (no alarms ( ) ( ) given)?

7. Will the atmosphere be continuously monitored while ( ) ( ) the space is occupied?

Contact the Fire Department (ext. 444) in the event of an emergency.

NOTE: If any of the above questions are answered "no," DO NOT ENTER and contact your immediate supervisor.

Job Location:

Signature Date

Industrial Hygienist or Designee

Appendix C

1. Manholes:

CONFINED SPACES LISTING

ELECTRICAL DISTRIBUTION

SYSTEM MANHOLES

1A 8A 20 30 41

1B 8B 21 31 42

1C 9 22 32 43

2A 10 23 33 44

2B 11 24 34 45

2C 12 24A 34A 46

3 13 25 35 47

4 14 26 36 48

5 15 27 37 49

6 16 27A 37A

6A 17 28 38

7 18 29 39

8 19 29A 40

SIGNAL DISTRIBUTION

SYSTEM MANHOLES

1 11 24 35A

2 12 25 36

2B 13 26 37

2C 14 27 38

3 15 27A 39

4 16 29 40

5 17 29A

6 18 30

7 19 31

7A 20 32

8 21 33

9 22 34

10 23 35

STEAM DISTRIBUTION SYSTEM MANHOLES

1 1H PT17 PT81 5A 11

1A 1I PT18 2 6 13

1B 1J PT41 3 6A 13A

1C 1K PT42 3A 7 13B

1D PT9 PT43 3B 8 13C

1E PT12 PT44 4 8A 15

Appendix C, continued

1F PT13 PT45 4D 9 15A

1G PT16 PT46 5 10 D

STORM MANHOLES

1 19 37 53 71 89

2 20 38 54 72 90

3 21 39 55 73 91

4 22 39A 56 74 92

5 23 40 57 75

6 24 41 58 76

7 25 42 59 77

8 26 43 60 78

9 27 43A 61 79

10 28 44 62 80

11 29 45 63 81

12 30 46 64 82

13 31 47 65 83

14 32 48 66 84

15 33 49 67 85

16 34 50 68 86

17 35 51 69 87

18 36 52 70 88

SANITARY SEWER MANHOLES

1 17 33 49 63B 78

2 18 34 50 63C 79

3 19 35 51 64 80

4 20 36 52 65 81

5 21 37 53 66 82

6 22 38 54 67 83

7 23 39 55 68

8 24 40 56 69

9 25 41 57 70

10 26 42 58 71

11 27 43 59 72

12 28 44 60 73

13 29 45 61 74

14 30 46 62 75

15 31 47 63 76

16 32 48 63A 77

Appendix C, continued

2. Miscellaneous Confined Spaces:

a. Four (4) boilers in Building 261, two chambers in each. Boilers and condensate receiver and deaerator, DA tank, wood chip bins, and feed water tank at Building 261.

b. Crawl space under Building 21.

c. Dust collector outside Building 22.

d. Two (2) water storage tanks on top of the hill.

e. Building 27 tunnel crawl space.

f. Elevator hoistways.

g. Two (2) well access vaults located at the well site.

3. Biomass Boiler Plant Confined Space Inventory:

a. Condensate outside pit Outside east side, conventional side.

b. DA tank East side, conventional side.

c. Treated water tank East side, conventional side.

d. Boiler #1 Conventional side, front and back.

e. Boiler #2 Conventional side, front and back.

f. Boiler #3 Conventional side, front and back.

g. Small brine tank West wall, conventional side.

h. Large outside brine tank Outside west side, conventional side.

i. Water softener #A West wall, conventional side.

j. Water softener #B West wall, conventional side.

k. Biomass furnace doors Biomass side.

l. Under grate ash doors Biomass side.

Appendix C, Continued

m. Under grate ash doors Biomass side.

n. Biomass boiler economizer door Biomass side.

o. Biomass boiler cyclone #1 door Biomass side.

p. Biomass boiler cyclone #2 door Biomass side.

q. East fuel bunker Biomass bunker room.

r. West fuel bunker Biomass bunker room.

s. Vibrating conveyor doors Biomass side.

t. Ash dumpster Outside east biomass side.

u. ESP north ash conveyor Outside east biomass side.

v. ESP south ash conveyor Outside east biomass side.

w. Fuel oil tank #1 Outside east biomass side.

x. Fuel oil tank #2 Outside east biomass side.

4. Elevator Pits

Building Number

1 P1

1 P2

7 F1

7 F2

9 P1

23 F1

24 P1

24 P2

Building Number

31 P1

31 P2

31 P3

31 P4

210 P1

210 P2

211 P1

211 P2

26 P1

26 P2

27 P1

27 P2

30 P1

30 P2

212 P1

35 P1

35 P2

28 P1