Confined space checklist

• Document No.

• Daily confined space checklist

• Vessel Name

• Conducted on

  Date

• Conducted by: suMan

• Location
  Address

• Job

  Hotwork

  Cold work

01

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

02

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

03

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

04

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

05

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

06

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

07

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

08

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

09

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

10

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

11

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

12

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

13

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

14

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work

15

• Tank name:

• Ventilation

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Gas condition

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Valid permit

  Yes

  No

  N/A

• Job

  Hotwork

  Cold work