Confined Space Pre-Entry Checklist

• Document No.

• Audit Title

• Site/Location

• Conducted on

  Date

• Site Supervisor

• This checklist is designed to be a pre-commencement checklist – either for use prior to actual entry or in the preparation of a Confined Space Entry (CSE) Permit to Work.
  It covers the most prevalent hazards associated with confined space entry but is not intended to be exhaustive – there is space at the end to allow local requirements or hazards to be included.

ITEM OR CONTROL DESCRIPTION - ARE CONTROLS IN PLACE & EFFECTIVE

• Are all workers inducted to site?

  Yes

  No

  N/A

• Are all workers trained in CSE?

  Yes

  No

  N/A

• Has a risk assessment been completed on the CSE task?

  Yes

  No

  N/A

• Is there a Safe Work Instruction for the task in the CSE?

  Yes

  No

  N/A

• Have all sources of energy been positively isolated?

  Yes

  No

  N/A

• Have the isolations been checked this shift?

  Yes

  No

  N/A

• Is atmospheric testing required and is there an authorised gas tester available?

  Yes

  No

  N/A

• Will constant atmospheric monitoring be required and is there a gas monitor available at the worksite?

  Yes

  No

  N/A

• Have all atmospheric monitors been challenge tested and are they within calibration date?

  Yes

  No

  N/A

• Is there any residue/sludge inside the confined space?

  Yes

  No

  N/A

• Will hot work be conducted inside and have the Hot Work permit controls been assessed and put into place?

  Yes

  No

  N/A

• Is the entry and egress point easy to access without any restrictions?

  Yes

  No

  N/A

• Is lighting required inside – is it Extra low voltage?

  Yes

  No

  N/A

• Is there a rescue plan in place?

  Yes

  No

  N/A

• Are rescuers required at the work front while the entry takes place?

  Yes

  No

  N/A

• Are electrical control boxes and safety switches managed from outside the space?

  Yes

  No

  N/A

• Are all gas cylinders (Oxy/Acetylene, etc.) outside the space and have flashback arrestors fitted?

  Yes

  No

  N/A

• Are Arc welding return leads placed so as to not create an induced current in other electrical equipment?

  Yes

  No

  N/A

• Is respiratory protection required – is it available and have personnel been trained in its use?

  Yes

  No

  N/A

• Have communications been established between the observer / supervisor outside and the work team inside?

  Yes

  No

  N/A

• Is a life line or other fall protection equipment required?

  Yes

  No

  N/A

• Is ventilation required during CSE – forced or natural? Is it monitored for effectiveness?

  Yes

  No

  N/A

• Are barricades required and are they in place?

  Yes

  No

  N/A

• Has the location of temporary equipment been assessed for exhaust, heat, ignition risk, etc.?

  Yes

  No

  N/A

• Is everyone aware of the emergency procedures?

  Yes

  No

  N/A

• SPECIFIC SITE REQUIREMENTS

  Yes

  No

  N/A

Have specialist PPE been made available in the correct sizes for the work team:

• - Rubber Boots

  Yes

  No

  N/A

• - Respirators

  Yes

  No

  N/A

• - Goggles and face shields

  Yes

  No

  N/A

• - PVC or other chemical gloves

  Yes

  No

  N/A

• - Welding helmets

  Yes

  No

  N/A

• - Other_______________________________

  Yes

  No

  N/A

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• Site Supervisor

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