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+: Emplo(e": 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 or would 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 do both 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 Re c!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 'e te" 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) Re c!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: <ain ;ines: 0rist%1nkle 3arnesses: Fire -4tin'uishers: "tretcher: ;adder (type) Re c!e E.!ipment In pection 5dentified rescue e6uip/ent inspected by co/petent person: #ecord of inspection(s) attached 9es ,edical E.!ipment Re.!i"ement (check where applicable below and indicate 6uantity needed): ,rau/a =it: $acka'in' &evice: Additional PPE Re.!i"ement (5ndicate what is needed): 3i'h 2isibility 2ests 3earin' $rotection "afety 7oots 3ard 3ats "afety :lasses%:o''les :loves Face "hield

De c"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"o/ed $(:

'itle:

Date:

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 the confined 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 une.pected hazard an unsafe act detects a condition prohibited by the permit (. "ntrants must e.it 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'e.posure an unacceptable condition arises an evacuation alarm is activated /n the event of a confined space rescue Rescuers 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 confirming the 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.