Confined Spaces Audit

• Document No.

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Personnel

Previous Inspection Report

• Has a confined spaces audit been completed in the previous 12 months

  Yes

  No

  N/A

• Have all impairments been actioned

  Yes

  No

  N/A

Confined Space

• List confined space: Location and Description

Confined Space

• Confined Space

• Signage in place

  Yes

  No

  N/A

• Access restricted and locked

  Yes

  No

  N/A

• Emergency winch anchor points in place

  Yes

  No

  N/A

Trained Personnel Register

• Has confined spaces training been recorded to staff training files

  Yes

  No

  N/A

• Add employee name
  

Employee

• Name

• Year of training

  Date

Confined Spaces Work Systems

• Entry permits available

  Yes

  No

  N/A

• Evidence that permits are being completed

  Yes

  No

  N/A

• Are completed permits stored in one place

  Yes

  No

  N/A

• Are completed permits being kept on file for at least 2 years

  Yes

  No

  N/A

• Are confined spaces emergency procedures available

  Yes

  No

  N/A

• Is there evidence that an emergency drill been practiced in the previous 2 years

  Yes

  No

  N/A

• Have all confined spaces trained staff completed refresher training in the previous 2 years

  Yes

  No

  N/A

• Has confined spaces awareness training been completed by other staff

  Yes

  No

  N/A

Confined Spaces Equipment

• Breathing apparatus available

• Record inspection date

  Date

• Air monitoring meter available

• Air Monitoring meter operational

  Yes

  No

  N/A

• Record inspection date

  Date

• Winch & tripod available

• Record inspection date

  Date

• Harness available

• List harness

Harness

• Record serial number

• Record inspection date

  Date

• Record use by date

  Date

Action Register

• List Impairments

Impairment

• Describe Impairment

• Select Priority Level

  Select Immediate Scheduled

  • Immediate
  • Scheduled

• Action required

• Who is responsible

• Date for action to be completed

  Date

Audit Sign Off

• Auditor Signature

  Sign

• Local Manager Signature

  Sign