4

Attachment 4 : Atmospheric Test Record

PLANT: TESTING SHEET NUMBER

CONFINED SPACE CSE NUMBER

DESCRIPTION

CONFINED SPACE PTW NUMBERS

REGISTER NUMBER

Gas test equipment number Calibration expired date

TEST PASS /
SUBSTANCE TO BE TESTED TWA/PEL NAME DATE TIME
RESULT FAIL
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11. Oxygen Level (%)

20 to 21.5
CERTIFICATION
I certify these results as a Pass Fail
Print Name Signature Date Time

Refer to attachment 2 for chemical TWA /PEL and set the gas meter to the correction factor of the particular chemical to be tested.
A minimum one hour ventilation required before a second test to be done if the first test Fail
Use a new sheet for the second test

Note : Entry into a ‘Confined Space’ should only be considered if the work cannot be accomplished from an external location