Confined Space Entry CPC

• Conducted on

  Date

• Prepared by

• Location
  Address

• Checked by:

• Position:

• Date/Time

  Date
• Location
  Address

• Contract:

Atmosphere, Engulfment, Ventilation & Fire

• 1. Has the atmosphere been tested and is it within the defined safe range?

  Yes

  No

  N/A

• 2. Are ventilation systems implemented effectively to ensure adequate ventilation, e.g. Dilution or Local Exhaust Ventilation (LEV)?

  Yes

  No

  N/A

• 3. Have ignition sources been eliminated where a flammable atmosphere exists?

  Yes

  No

  N/A

• 4. Have controls associated with engulfment been implemented effectively?

  Yes

  No

  N/A

Plant & equipment testing

• 5. Is the gas monitor calibrated and bump tested prior to use?

  Yes

  No

  N/A

• 6. Is correct confined space entry equipment available and tested to the relevant standard, e.g. harnesses and rescue equipment?

  Yes

  No

  N/A

Permit & Procedures

• 7. Has a risk assessment been completed and controls implemented effectively?

  Yes

  No

  N/A

• 8. Has an entry permit been issued for each confined space entry and controls implemented effectively?

  Yes

  No

  N/A

People & Training

• 9. Are all employees involved in the confined space work suitably trained and assessed as competent?

  Yes

  No

  N/A

Isolation

• 10. Are all energy sources controlled and locked out?

  Yes

  No

  N/A

• 11. Are all entry points to the identified confined space signposted and barricaded off to prevent unauthorised entry?

  Yes

  No

  N/A

Standby Communications

• 12. Can the standby person (attendant) maintain continuous communication with employees working in the confined space?

  Yes

  No

  N/A

Interactions

• 13. Are controls associated with other work party interactions implemented effectively? (e.g. other workers, plant and equipment)

  Yes

  No

  N/A

Emergency Response

• 14. Is there a documented rescue and emergency plan available on site and are all work parties aware of the agreed process?

  Yes

  No

  N/A

• 15. Is rescue equipment set up or available on site?

  Yes

  No

  N/A