Confined Space Pre-Entry Inspection

• Confined Space ID or #

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

General Information

• Type of Confined Space

  Select tank vessel storage bin hopper pit vault manhole pipeline sewer ductwork Other

  • tank
  • vessel
  • storage bin
  • hopper
  • pit
  • vault
  • manhole
  • pipeline
  • sewer
  • ductwork
  • Other

• other confined space type

• Take a photo of the confined space

  Media

• How often is this space entered?

  Select Daily Weekly Monthly Twice annually Annually As needed

  • Daily
  • Weekly
  • Monthly
  • Twice annually
  • Annually
  • As needed

• Work to be performed

• Equipment to be worked on

• Name of Entry Supervisor

• Name of the Entrant/s

• Name of the Attendant/s

• Classification of Confined Space

  Non-Permit

  Permit Required

Area, Atmosphere Testing & Ventilation

• Is the space posted with a sign stating “Danger – Follow Confined Space Entry procedure”?

  Yes

  No

  N/A

• REFERENCE: A sign required to be posted in the entrance of the confined space
  [This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

  

• Are confined spaces thoroughly emptied of any corrosive, hazardous or decaying substance that may produce a hazardous atmosphere?

  Yes

  No

  N/A

• Was atmospheric hazard testing done in the proper order? (oxygen, then combustible gases and vapors and then toxic gases and vapors)?

  Yes

  No

  N/A

• Is the ventilation adequate?

  Yes

  No

  N/A

• Is the ventilator safe and grounded?

  Yes

  No

  N/A

• Was atmospheric hazard testing repeated after ventilation?

  Yes

  No

  N/A

• Is there an entrance barricade installed?

  Yes

  No

  N/A

Training

• Has each employee been trained and demonstrated a proficiency in the understanding, knowledge, and skills necessary for the safe performance of duties relating to the confined space?

  Yes

  No

  N/A

• Have the entrants been trained in the hazards of the entry, the signs of exposure, to properly use the equipment and communicate with the attendant?

  Yes

  No

  N/A

• Have the attendants been trained in the hazards of the entry, to recognize behavioral effects of hazard exposure in authorized entrants and to call for rescue services if necessary?

  Yes

  No

  N/A

• Has the employer evaluated the rescuers or emergency service’s ability to respond in a timely manner?

  Yes

  No

  N/A

Equipment and PPE

• Is the entrant wearing proper PPE?

  Yes

  No

  N/A

• Are fall protection gears (harness and lifelines) used?

  Yes

  No

  N/A

• Is self-contained breathing apparatus available if needed?

  Yes

  No

  N/A

• Are the tools to be used explosion proof?

  Yes

  No

  N/A

• Has necessary lighting equipment been provided?

  Yes

  No

  N/A

• Is there a continuous gas monitoring device in place?

  Yes

  No

  N/A

Permit

• Are all the employees involved in the entry listed on the permit?

  Yes

  No

  N/A

• Has the entry supervisor signed off on the permit indicating that entry conditions are acceptable?

  Yes

  No

  N/A

• Are completed entry permits posted near the confined space entrance for all involved to observe?

  Yes

  No

  N/A

• Are the permits saved for one year for review?

  Yes

  No

  N/A

Recommendations

• Write recommendations here

Completion

• Full Name and Signature of the Inspector

  Sign