Confined Space Entry

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location of Work

• Description of Work(trades)

• Employee's Assigned

• Entry Date & Time

  Date

• Outside Contractors

Isolation Checklist

• Blanking and/or Disconnecting

• Electrical

• Mechanical

• Other

Hazardous Work

• Burning

• Welding

• Brazing

• Open Flame

• Other

Hazards Expected

• Corrosive Materials

• Hot Equipment

• Flammable Materials

• Toxic Materials

• Drains Open

• Cleaning(e.g. Chemical or Water Lance)

• Spark Producing Operations

• Spilled Liquids

• Pressure Systems

• Other

Vessel Cleaned

• Deposits

• Method

• Inspection

• Neutralized with

• Fire Safety Precautions

Personal Safety

• Ventilation Requirements

• Respirators

• Clothing

• Head, Hand, Foot Protection

• Shields

• Life Lines & Harnesses

• Atmospheric Gas Tests

• Communications

• Employee Qualified

• Buddy system

• Stand-by Person

• Emergency Egress Procedures

• Training Sign Off(supervisor or qualified person)

  Sign

Testing

• Test Performed, Location & Reading

• Test Performed, Location & Reading

• Test Performed, Location & reading

• Test Performed, Location & Reading

• Remarks

• Test Performed by

  Sign

Authorizations

• Supervisor

• Production Supervisor

• Line Supervisor

• Safety Supervisor

• Other

Entry & Emergency Procedures Understood

• Stand-by Worker

• Rescue

• Telephone

• Permit Expires

• Classification