Skip Navigation
finance and administration
risk management

Confined Space Entry Request

This form must be completed and submitted to MUSC Occupational Safety and Health Programs at least 24 hours prior to the proposed entry into a confined space. Approval of requests less than 24 hours before the proposed entry will be left to the discretion of OSHP. For emergency confined space entry, please complete this form and call OSHP at 843-792-3604. Confined space entry requests must be submitted by managers or supervisors responsible for the project.

Minimum Personal Protective Equipment: Work Gloves, Hard Hat, Safety Glasses to be worn during work in confined spaces unless otherwise assigned by the supervising manager. See PPE section below for more information.

Please fill out the form below and click submit. Your request will be e-mailed to Occupational Safety and Health. If you require assistance or have questions about this form, please call 843-792-3604. Fields marked with * are required.

Employee Confined Space Work
Detailed explanation of work to be performed. Includes any hazards that may be encountered by performing this work. This includes, but is not limited to: chemicals hazards, electrical/energy hazards, fire hazards (open flames, welding, cutting, hot work, etc.), temperature extremes (summer/winter weather), noise generated, source of heat or cold (steam), dust, radiation hazards, biological hazards, etc.
Detailed explanation of methods to control hazards (include any lockout/tagout procedures that will be performed prior to entry, forced air ventilation that will be provided, barriers between entrants and hazards, and any other methods of hazard control to by implemented).
Personal Protective Equipment (PPE)
The supervisor has the right to request that entrants wear additional or different PPE.
Other PPE


Attendant:  An attendant must be present at all times during confined space entry.  The attendant must stay in the immediate vicinity of the confined space entrance, may never enter the confined space under any circumstances, and is responsible for keeping constant communication with the entrants. 

Signage & Barriers: You are responsible for ensuring that the confined space access area (i.e. manhole cover, vaults, trap doors) is clearly labeled and is blocked off in a manner that prevents unauthorized access during the confined space entry.  Examples of this are traffic cones and caution tape.

Communication:  You are responsible for providing communication devices for all personnel entering the confined space and for the attendant outside of the confined space.  2-way radios are appropriate for this type of communication.  Cellular devices are not appropriate as they may not work effectively in areas underneath the ground or deep within building structures.   The attendant must keep in communication with confined space entrants by performing radio and atmosphere monitor checks at least every 15 minutes.

OSHP has the right to deny access to a confined space if necessary requirements are not met.


© Medical University of South Carolina | Disclaimer | Charleston Memorial Hospital, 326 Calhoun Street, Suite 190, MSC 184, Charleston, South Carolina, 29425
Phone: 843-792-3055  - Fax: 843-792-6607