• Project description

  • Contract No. GW

  • Contractor

  • Subcontractors on site

  • Conducted on

  • Prepared by

  • Location
  • Contractor's representative

1.0 Site Setup

  • 1.1 Has the Contractor set up the site safely? Items to consider include appropriate signs and barricades, traffic control, prevention of access by the public, minimised risk of falls into deep pits/holes. <br>No smoking on site.

2.0 Equipment

  • 2.1 Does the Contractor have all the necessary equipment on site for this entry? Items to consider include safety harnesses, lanyards, tripod, lifting blocks, breathing apparatus, gas detector, appropriate PPE, breathing apparatus, ventilation fans. Is equipment in good condition, test dates OK?

3.0 Prior to Entry

  • 3.1 Has a gas check been done, risk analysis undertaken and permit been filled out correctly, have all necessary isolations been done, has the confined space been ventilated if required and are gas levels within safe limits?

  • 3.2 Are there a minimum of three people on site, are all personnel CSE trained and refreshers up to date, is there a first aider on site and has an emergency plan been discussed and understood by everyone?

4.0 During Entry

  • 4.1 Is the gas level continuously monitored if required?

  • 4.2 Are there at least two people at ground level at all times? Is appropriate communication maintained with personnel in the confined space?

  • 4.3 Is ‘Hot Work’ being undertaken? If yes then appropriate precautions and a hot work permit are required.

5.0 At Completion of Work

  • 5.1 Have all personnel exited the confined space safely? Has the site been made safe, all covers replaced, isolations restored, equipment packed up correctly to prevent damage?

  • CSE permit to be signed off and completed.

Additional comments

  • Add additional comments

Action Required

  • Contractor is to review the comments, and consider the recommended actions within this audit. The contractor needs to demonstrate they are complying with their obligations as an employer, what specific remedial action they propose for this site, and if any overall modifications are required to their Health and Safety Plan / safety procedures / supervision. Prompt corrective action is required to eliminate any agreed deficiencies, and any areas of disagreement need to be further explored in writing. All “failed responses” need to be addressed/resolved.


  • Gippsland Water responsible officer

  • Auditor

  • Contractor's representative

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