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University of Houston - Victoria

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Campus Safety Manual

Confined Space Entry Log
And
Debriefing Documentation

CONFINED SPACE: _______________________________________________

BUILDING: ______________________________________________

STANDBY ASSISTANT(S: __________________________________________ __________________________________________

CONFINED SPACE ENTRY SUPERVISOR: __________________________________________________

Print Name of Authorized Entrant Signature of Authorized Entrant Date of Entry Time In Time Out Did you encounter unusual or an unexpected hazard? Do you have any recommendations to improve this confined space entry?
1. 1.          
2. 2.          
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8. 8.          
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11. 11.          
12. 12.          

 

Safety Manual: Table of Contents