Confined Space Supervisory Responsibilities Checklist

• Client / Site

• Location
  Address

• Space #

• Conducted on

  Date

• Prepared by

SUPERVISORY RESPONSIBILITIES

• Supervisors shall identify and report all job areas and locations that are or may be confined spaces.

  ✔

  ✖

  N/A

• Maintain and provide a list of confined spaces that are identified which shall be submitted to the Safety Organization.

  ✔

  ✖

  N/A

• In addition, the designated supervisors shall carry out the following tasks:

• Classify confined spaces as "permit required," “Alternate Procedure” or "non-permit required.”

  ✔

  ✖

  N/A

• Identify personnel who will enter confined spaces.

  ✔

  ✖

  N/A

• Identify the personnel under their supervision required to wear respirators.

  ✔

  ✖

  N/A

• Advise personnel on routine measurement of respiratory hazards in confined spaces.

  ✔

  ✖

  N/A

• Provide detailed instruction and training on confined space hazards and entry procedures to those who may enter confined paces.

  ✔

  ✖

  N/A

• Provide instruction to personnel on the proper use of equipment required for confined space entry.

  ✔

  ✖

  N/A

• Maintain equipment that is used to enter confined spaces.

  ✔

  ✖

  N/A

• Maintain records of equipment maintenance and employee training.

  ✔

  ✖

  N/A

• Inform employees who may enter the permit confined space by posting danger signs or by training.

  ✔

  ✖

  N/A

• Issuance and cancellation of entry permits.

  ✔

  ✖

  N/A

• Establishment of a lockout program for their department.

  ✔

  ✖

  N/A

• Identify and evaluate the hazards of permit spaces before employees enter them.

  ✔

  ✖

  N/A

• Conduct a pre-entry briefing to inform entrants of possible hazards that may be encountered.

  ✔

  ✖

  N/A

• Identify the people who will enter the confined spaces.

  ✔

  ✖

  N/A

• Take the necessary measures to prevent entrance into prohibited permit spaces.

  ✔

  ✖

  N/A

DUTIES OF THE “LEAD WORKER” (ENTRY SUPERVISOR)

• Know the potential hazards during entry and work.

  ✔

  ✖

  N/A

• Determine if acceptable entry conditions are present at a permit space where entry is planned.

  ✔

  ✖

  N/A

• Terminate entry as required by the standard.

  ✔

  ✖

  N/A

• Verify that rescue services are readily available and the means for summoning them are operable.

  ✔

  ✖

  N/A

• Remove unauthorized individuals who enter or try to enter the permit space during entry and work.

  ✔

  ✖

  N/A

• Determine that entry and work operations remain consistent with entry permit terms and that acceptable entry conditions are maintained.

  ✔

  ✖

  N/A

• Determine if entry into confined space is necessary to perform work.

  ✔

  ✖

  N/A

MINIMUM REQUIRED EQUIPMENT

• The following minimum required equipment should be on hand:

• Ventilation

  ✔

  ✖

  N/A

• Barrier and warning signs

  ✔

  ✖

  N/A

• Gas monitor capable of measuring concentrations of oxygen, flammable gases, hydrogen sulfide and carbon monoxide.

  ✔

  ✖

  N/A

• Eliminate any unsafe conditions before the access door or cover is opened.

  ✔

  ✖

  N/A

HAZARD ASSESSMENT

• Test the real or potential atmospheric hazards

  ✔

  ✖

  N/A

• Oxygen content less than 19.5% or greater than 23.5%

  ✔

  ✖

  N/A

• Flammable gases and vapors greater than 10% of the LEL (Lower Explosive Limit)

  ✔

  ✖

  N/A

• Hydrogen Sulfide concentrations greater than 10 ppm (Parts per million)

  ✔

  ✖

  N/A

• Carbon Monoxide concentrations greater than 35 ppm

  ✔

  ✖

  N/A

• Review the space for other observable serious safety and health hazards

  Select Mechanical Electrical Fire Heat stress Engulfment Entrapment hazards Other

  • Mechanical
  • Electrical
  • Fire
  • Heat stress
  • Engulfment
  • Entrapment hazards
  • Other

• Is there any hazardous atmosphere detected?

  Yes

  No

• Determine and eliminate the source of the atmospheric hazards (for example: carbon monoxide from nearby truck or gas-powered generator).

  ✔

  ✖

  N/A

• When the atmosphere contains toxins or flammables, ventilate the space by drawing air out until the air has been changed over several times.

  ✔

  ✖

  N/A

• When oxygen deficient, ventilate by pushing air into the space until the air has been changed over several times.

  ✔

  ✖

  N/A

• Verify the hazardous atmosphere has been eliminated by testing the air.

  ✔

  ✖

  N/A

• From information gathered above, determine which of the following entry procedures is appropriate: Non-Permit Space - If there are neither real nor potential atmospheric hazards and no observable serious safety and health hazards, this should be certified in writing. Alternative Entry Procedures – If no observable serious safety and health hazards exist and atmospheric hazards are controlled with continuous ventilation; this should be certified in writing. Permit-Required Space - If there are any observable serious safety/health hazards in addition to potential or real atmospheric hazards, all procedure here must be followed. Authorize permit with signature. Non-Respirable Atmospheres - If hazardous atmosphere cannot be eliminated by continuous ventilation, contact the Safety Organization before continuing.

  Select Non-Permit Space Alternative Entry Procedures Permit-Required Space 49. Non-Respirable Atmospheres

  • Non-Permit Space
  • Alternative Entry Procedures
  • Permit-Required Space
  • 49. Non-Respirable Atmospheres

PRE-ENTRY PRECAUTIONS

• Notify affected departments of service interruption.

  ✔

  ✖

  N/A

• Lock-out/tag-out all sources of energy (e.g. steam, electric, mechanical) posing a risk to workers.

  ✔

  ✖

  N/A

• Install blank in affected pipes where valves are not secure or seated.

  ✔

  ✖

  N/A

• Clean and/or purge any chemical storage vessel.

  ✔

  ✖

  N/A

• Wear appropriate personal protective and respiratory protection.

  ✔

  ✖

  N/A

• Have lights and or ladder available.

  ✔

  ✖

  N/A

• If coordination is needed with contractors, see Contractor Checklist.

  ✔

  ✖

  N/A

• Have appropriate MSDS's (Material Safety Data Sheet).

  ✔

  ✖

  N/A

• Determine how often air monitoring will be conducted.

  ✔

  ✖

  N/A

COMPLETION

• Full Name and Signature of Entry Supervisor/Authorized Personnel