Information

  • Document No.

  • Audit Title

  • Site

  • Conducted on

  • Prepared by

  • Personnel

Previous Inspection Report

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

  • Have all impairments been actioned

Confined Space

  • List confined space: Location and Description

  • Confined Space
  • Confined Space

  • Signage in place

  • Access restricted and locked

  • Emergency winch anchor points in place

Trained Personnel Register

  • Has confined spaces training been recorded to staff training files

  • Add employee name

  • Employee
  • Name

  • Year of training

Confined Spaces Work Systems

  • Entry permits available

  • Evidence that permits are being completed

  • Are completed permits stored in one place

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

  • Are confined spaces emergency procedures available

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

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

  • Has confined spaces awareness training been completed by other staff

Confined Spaces Equipment

  • Breathing apparatus available

  • Record inspection date

  • Air monitoring meter available

  • Air Monitoring meter operational

  • Record inspection date

  • Winch & tripod available

  • Record inspection date

  • Harness available

  • List harness

  • Harness
  • Record serial number

  • Record inspection date

  • Record use by date

Action Register

Action Register

  • List Impairments

  • Impairment
  • Describe Impairment

  • Select Priority Level

  • Action required

  • Who is responsible

  • Date for action to be completed

Audit Sign Off

  • Auditor Signature

  • Local Manager Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.