Critical Control Field Verification - Confined Space V1

• COWAL UNDERGROUND EXPANSION PROJECT - 60668781

• Conducted on:

  Date

• Prepared by:

• Site location:

  Select

• State location.

• TASK UNDERTAKEN:

• SWMS / JHA USED:

• Have all persons working signed onto SWMS / JHA?

  Yes

  No

  N/A

• CONTRACTOR OBSERVED:

  Select

• Name of Contractor.

• SHIFT:

  Day

  Night

Note: If a Critical Control cannot be verified, the task shall be stopped, and the controls re-evaluated to ensure that all Critical Controls are in place

• Are all personnel working at the confined space trained and competent?

  Yes

  No

  N/A

• Has a gas test been conducted and have the results been recorded?

  Yes

  No

  N/A

• Does the monitoring equipment have a valid calibration certificate?

  Yes

  No

  N/A

• Has a confined space permit been completed and signed by all personnel involved in the task?

  Yes

  No

  N/A

• Has a rescue plan been established and is it understood by all personnel involved in the task?

  Yes

  No

  N/A

• Is a sentry present and are they controlling entry and exit points?

  Yes

  No

  N/A

• Is the sentry using an effective means of communication with personnel inside the confined space?

  Yes

  No

  N/A

• Have all energy sources been de-energised, isolated, and confirmed de-energisation?

  Yes

  No

  N/A

• Has ventilation been provided?

  Yes

  No

  N/A

• Is the work area clear of materials that could fall within the confined space?

  Yes

  No

  N/A

• Notes:

NOTIFICATIONS

• Does anyone need to be notified of the actions identified in this report?

  Yes

  No

  N/A

• Select name/s of who needs to be notified.

  Select

INSPECTION TEAM

• NAME & SIGNATURE

  Sign

• NAME & SIGNATURE

  Sign

• NAME & SIGNATURE

  Sign

• NAME & SIGNATURE

  Sign

• NAME & SIGNATURE

  Sign