Permit Request • CampusOptics

THE UNIVERSITY OF TEXAS AT DALLAS - Permit Required Confined Space (PRCS) Notification

All PRCS notification(s) should be made at least 24-hours in advance, unless entry is due to an emergency situation.
All UTD personnel and UTD Contractors are required to follow their internal Confined Space Entry policy/procedures per OSHA standards 29 CFR 1910.146 and/or Subpart AA of 29 CFR 1926.

Directions:

To make a Notification, please complete the information below. Once completed, click the Submit Permit Request button located at the bottom of this form. If the information in this notification changes following the initial submission, please complete and submit a NEW notification with the updated information.
This is a notification form, not a confined space entry permit. UTD Safety is available to provide pre-entry support. As a courtesy, you will receive a follow-up email showing receipt of this notification form.
Work may proceed once YOUR ENTRY SUPERVISOR has determined that acceptable entry conditions have been met. If you are a UTD Contractor, you may proceed per direction from your UTD contact.

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Campus, Building, or Outdoor Area* Required

Additional Location Details

Are you also the ENTRY SUPERVISOR?* Required

If you are NOT the Entry Supervisor, provide the name and phone number of the designated ENTRY SUPERVISOR* Required

List the names of all personnel that will be entering into the confined space ("entrants")* Required

List the names of all personnel that are assigned as "attendants" for this entry* Required

If you are a UTD contractor, provide your Company Name and the name of your UTD Contact/Project Manager for this work* Required

Confined Space Tag Number (if present)* Required

Additional Location Details (if no Confined Space Tag is present)* Required

Please describe the exact purpose for entry into the confined space (example: run new fiber cable between Building A and Building B)* Required

List all chemicals or materials being brought into the space (or enter "none" in the response space)* Required

List all PPE (personal protective equipment) that entrants will wear while in the confined space* Required

Is supplemental ventilation being provided during entry into this confined space?* Required

Is atmospheric/air monitoring being conducted prior to and during entry?* Required

Have all mechanical, electrical, entrapment, and engulfment/drowning hazards been eliminated or controlled prior to entry?* Required

Have you ensured that a rescue plan and any necessary rescue devices are in place, prior to entry?* Required

Add files to upload as supporting documentation along with your permit request.

Files