This form must be filled out and signed by a Confined Space Entry Supervisor or a Qualified Health and Safety Professional. An Alternate Entry Certificate is valid for a single shift. The following evaluation is consistent with OSHA 29 CFR 1910.146(c)(5).
Entry Supervisor (or Health and Safety Professional) - Complete the following:
*Entry Supervisor must notify the Office of Environmental Health and Safety of the scheduled entry and alternate procedures prior to entry activities.
If the answer to any of the above question is "No" then alternate entry procedures cannot be used and entry must be performed under permit conditions.
A copy of this certificate must remain at the entry site for the duration of the entry or shift, whichever is shorter. This certificate is considered valid for no greater than 1 shift or 8 hours. A copy of this form must be provided to the UNH Office of Environmental Health and Safety upon completion of entry into the space. The department overseeing the entry is responsible for maintaining a copy of this form on file for a minimum of 1 year.
Name of Supervisor or Health & Safety Professional: