Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Confined space

  • Add media

  • Has the tank been vented for 24 hrs

  • Is there adequate ventilation, either forced or natural for the task

  • Add media

  • Is the risk assessment suitable and sufficient for the task

  • Add media

  • Has a tollbox talk / JSA been completed and signed off by all personnel on the task

  • Add media

  • Has a permit to work been raised and signed off by the appropriate responsible person

  • Add media

  • Are copies of the permit to work available in the correct locations

  • Add media

Training

  • Are all personnel trained in confined space

  • Add media

  • Do all personnel know how to raise the alarm and summon help

  • Are the personnel trained in confined space rescue

  • Add media

  • Are personnel trained in the use of harness, lanyards or restraints

  • Add media

  • Do all personnel understand how to use the tripod<br>

  • Add media

  • Are personnel trained in the use of gas testers

  • Add media

Testing

  • Has the confined space been gas tested

  • Add media

  • Is the gas tester calibrated and in date

  • Add media

  • Have personnel gas detectors been issued

  • Add media

  • Has a personnel gas tester been lowered into the tank prior to entry for the required time

  • Add media

  • Have the radio's been issued and operationally checked, including specified channel selected

  • Add media

Emergency requirements

  • Escape set issued

  • Add media

  • Escape set tested and available in an emergency

  • Add media

  • Are all personnel wearing suitable harness, lanyards or restraints for the specific task

  • Add media

  • Tripod set up on entry point

  • Add media

  • Tank sentry present

  • Add media

  • Please provide details of the last emergency response practice that has taken place

  • Select date

Signage

  • Is there a gas free tag in place

  • Add media

  • Ample warning signs in place, to warn others of tank entry

  • Add media

Other hazards

  • Is there suitable lighting for the task

  • Add media

  • Are all personnel clipped on at all times

  • Add media

  • Is there adequate barriers around the area to prevent other personnel falling or coming into contact with the structure

  • Add media

  • Are there Mechanical Hazards? If Yes, list.

  • Are there Electrical Hazards? If Yes, list.

  • Are there Heat and/or Cold Safety Concerns? If Yes, Explain.

  • Is there a potential for Reduced Visibility? If Yes, Explain.

  • Is there a Noise Concern? If Yes, Explain.

  • OTHER Hazardous Concern NOT listed?

PPE

  • Are all personnel warning the correct PPE for the task and as stated in the risk assessment and toolbox/ JSA

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.