University of Guelph Environmental Health & Safety Form
July 2018
Confined Space Multiple Contractor Co-ordination Letter
(1)
Name
Title
Employer (Contractor)
Address
(2)
Name
Title
Employer (Contractor)
Address
(3)
Name
Title
Employer (Contractor)
Address
(4)
Name
Title
Employer (Contractor)
Address
Date:
Re: Multi-Employer Co-ordination Document for Entry/Work in Confined Spaces:________________________
Where the workers of more than one employer are to perform work in the same confined space or related work with
respect to the same confined space, and before any worker enters the confined space or begins related work with
respect to the confined space, the University of Guelph as the lead employer is required by Ontario Regulation
632/05, Confined Spaces made under the Occupational Health and Safety Act of Ontario, to prepare a co-ordination
document to ensure that the duties imposed on employers by the regulation are performed in a way that protects the
health and safety of all workers who perform work in the confined space or related work with respect to the confined
space. As a matter of general information, this co-ordination document is intended to ensure that employers of
workers working in a confined space are aware of potential or existing hazards that may be introduced by one or the
other employer, and that there is communication between the employers in order to ensure worker safety. Also, the
intent is to reduce duplication with respect to requirements such as the hazard assessment, plan, entry permit and
procedures to follow in the event of an emergency but the document does not allow for sharing of responsibilities for
general training, personal protective equipment and records.
Attached, please find the following documents regarding confined space(s) # _______________________________:
• hazard assessment • plan • entry permits • procedures to follow in the event of an emergency; these documents
will be available and reviewed with all entrants and other related personnel prior to entry into the confined space.
__________________ __________________ (Name and Department of University’s Confined Space Supervisor)
__________________ __________________ (Date and Signature of University’s Confined Space Supervisor)
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CONTRACTED EMPLOYER(S) ACKNOWLEDGEMENT
We the undersigned:
• have read and will comply with the requirements of Ontario Regulation 632/05;
• have read and will comply with the requirements of the University of Guelph Confined Spaces Management
Program. We have received documentation regarding the hazard assessment, written plan, plan-specific training
(as appropriate), entry permit and procedures to follow in the event of an emergency;
• have provided written evidence that all workers who are required to perform entry/work in the confined space or
related work with respect to the same confined space have received appropriate training and instruction in
accordance with the University of Guelph Confined Spaces Program.
Employer Name/Title of Employer
Representative
Signature/Date of Employer
Representative
1
2
3
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click to sign
signature
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