confined space rescue plan template

8/13/2019 Confined Space Rescue Plan Template

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CONFINED SPACE RESCUE PLAN (template)Confined Space Name/Location: Identification #: Date:

Confined Space i !nde" a p!"e o" ine"t $lan%et: &/N 'pe of a:Ent" *atc+: Emploe":

For this specific confined space entry we have decided to use:

Non-entry rescue procedures (do not use if this would increase the risk of injury to the entrant orwould be ineffective).

On-site rescue services which include: (list) !) On-"ite #escue $ersonnel%&esi'nation ) ) *) ) +)

Off-site entry rescue services.,he ntry "upervisor will contact(name of rescue service)at(phone number) to doboth of the followin':

oordinate entry

"chedule an entry date and ti/e,et+od of Comm!nication:

"afety 0atch to #escue $ersonnel: $hone 1udible "i'nal #adio (channel to monitor)

Other

"afety 0atch to ntrants: #adio (channel to monitor) 1udible "i'nal 2isual 3and "i'nal

#ope "i'nal Other "afety 0atch to $erson in har'e of area: $hone 1udible "i'nal #adio Other

,et+od of Rec!e: 4ternal (#etrieval) 5nternal: on'ested:

3aulin' "yste/ #e6uired: $atient lowerin' syste/ re6uired%lowerin' area: 1nchor overhead:

1nchora'e: 7ea/ "tairwell "upport "trut "upport olu/n Other:

$re-#i''in' re6uired8 9es No

-"eat+in E.!ipment and a 'ete" Re.!i"ement(check where applicable below and indicate

6uantity needed): "71: 1irline #espirators: o/pressor (rade & 1ir):

1ir $urifyin' #espirators (specify nu/ber and type re6uired): as ,esters: (specify nu/ber and type re6uired): "tand-by 1ttendant (re6uired to /onitor co/pressor intake) Rec!e E.!ipment Re.!i"ement (check where applicable below and indicate 6uantity needed):

3aulin' "yste/s: arabineers: $ulleys: "hock absorbers%lanyards: 1nchor "traps: 0ebbin': 1scenders: 7ody 3arnesses: #i''in' $lates: "afety ;ines:


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Dec"iption of Space (include location of "afety 0atch):

Dia"am of Space (>se 7ack of $a'e if needed): 5nclude direction of approach and any sta'in' areas.

App"oed $: 'itle: Date:


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ON-SITE RESCUE PROCEDURES

These procedures form part of the written Confined Space Rescue Plan and are based on the assessment

of hazards in the named confined space. These procedures must be amended to include any specific

procedures for summoning rescue and emergency services for the worksite.

Prior to entry and/or work in the confined space!. The "ntry Supervisor shall ensure that the attached confined space rescue plan template has been

completed and that all the rescue e#uipment identified in the plan is available to effect a rescue in theconfined space.

$. The "ntry Supervisor shall ensure that an ade#uate number of appropriately trained persons %as

documented in the attached rescue plan& are available for immediate implementation of these on'site

rescue procedures that apply to the confined space.

(. The "ntry Supervisor shall review all emergency procedures) including procedures relating to

emergencies outside the confined space with all entrants and other related personnel.

*. The "ntry Supervisor shall confirm that the rescue e#uipment is located at the agreed staging area.

+. The Safety ,atch shall establish communication with all workers) using the means described in the

attached rescue plan.

-n entry and while working in the confined space

!. The Safety ,atch who is stationed outside and near the entrance to the confined space as described in

the attached rescue plan remains in constant communication with all workers inside the confined

space.$. The Safety ,atch must be notified immediately if an entrant recognizes

unusual action or behavior of other entrants

an unepected hazard

an unsafe act

detects a condition prohibited by the permit

(. "ntrants must eit the confined space as #uickly as possible) when

an order to evacuate is given by the Safety ,atch or "ntry Supervisor

an entrant recognizes a sign or symptom of over'eposure

an unacceptable condition arises

an evacuation alarm is activated

n the event of a confined space rescueRescuers must strictly follow safe rescue procedures.

!. The Safety ,atch shall not enter the confined space but immediately summon a rescue response from

the designated rescue team) using the means of communication described in the attached rescue plan.

$. 0nit operator and any available 1irewatch in the area will respond to the location of the alarm.

(. 2ualified 3as Tester will test inside the confined space to determine if the environment is safe for

entry.

*. 4fter confirmingthe environment is not the cause of the person down) then competent first aid /rescue personnel e#uipped with the necessary safety e#uipment will be admitted to the space to attend

to the person) and prepare them to be moved out.

+. f the atmosphere is found unsafe for entry without breathing air then rescue personnel must put on

SC54 or airline respirators prior to entry.

6. 0sing applicable rescue techni#ues to move the person) the in7ured person will be moved out of the

confined space to a safe location by the recue team.

8. 4n ambulance can safely transport the individual to the hospital if necessary.9. :ist other additional site specific steps as necessary.

confined space rescue plan template

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