Information
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Document No.
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Audit Title
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Site
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Conducted on
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Prepared by
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Personnel
Previous Inspection Report
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Has a confined spaces audit been completed in the previous 12 months
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Have all impairments been actioned
Confined Space
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List confined space: Location and Description
Confined Space
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Confined Space
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Signage in place
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Access restricted and locked
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Emergency winch anchor points in place
Trained Personnel Register
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Has confined spaces training been recorded to staff training files
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Add employee name
Employee
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Name
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Year of training
Confined Spaces Work Systems
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Entry permits available
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Evidence that permits are being completed
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Are completed permits stored in one place
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Are completed permits being kept on file for at least 2 years
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Are confined spaces emergency procedures available
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Is there evidence that an emergency drill been practiced in the previous 2 years
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Have all confined spaces trained staff completed refresher training in the previous 2 years
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Has confined spaces awareness training been completed by other staff
Confined Spaces Equipment
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Breathing apparatus available
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Record inspection date
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Air monitoring meter available
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Air Monitoring meter operational
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Record inspection date
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Winch & tripod available
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Record inspection date
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Harness available
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List harness
Harness
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Record serial number
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Record inspection date
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Record use by date
Action Register
Action Register
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List Impairments
Impairment
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Describe Impairment
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Select Priority Level
- Immediate
- Scheduled
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Action required
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Who is responsible
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Date for action to be completed
Audit Sign Off
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Auditor Signature
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Local Manager Signature