Fatal Risk Critical Control Verification - Confined Space

• Prepared by:

• Location:

• Date:

  Date

• Brief Description of Task/Activity

• Document Number:

• Make sure you know which Fatal Risks are present in your work area!

  

• If any fatal risk controls are not effectively implemented or maintained the task/activity should be stopped immediately and the related risks needs to be re assessed by a competent person.

Confined Space

• These CRITICAL CONTROL needs to be in place when working in confined space.

  

• Does the activity present confined space risks.

  Yes

  No

Competency

• Has the worker been trained and authorized, and does the worker understand the components of confined space activity?

  Yes

  No

  N/A

Confined Space Permit

• Has the Confined Space Permit been completed and implemented correctly?

  Yes

  No

  N/A

• Is the attendant/spotter present while confined space is occupied?

  Yes

  No

  N/A

• Is the confined space attendant/spotter maintaining a register of people entering and exiting?

  Yes

  No

  N/A

• Are all confined space entry and exit locations guarded or barricaded and labeled to prevent unauthorized entry?

  Yes

  No

  N/A

• Is there effective communication between the confined space spotter/attendant and entrants?

  Yes

  No

  N/A

• Has a risk assessment been conducted and have proper controls been established for each risk identified?

  Yes

  No

  N/A

Atmospheric Testing and Monitoring

• Has the appropriate gas monitor been selected, pre-use bump tested conducted and valid calibration for use based on the identified hazards?

  Yes

  No

  N/A

• Is the atmosphere being tested, results documented per confined space permit, and appropriate controls implemented as per plan?

  Yes

  No

  N/A

Energy Isolation

• Have all sources of energy been identified, isolated by each occupant's personal lock, tagged, tried out, and in a zero-energy state?

  Yes

  No

  N/A

Emergency Response

• Do attendant and entrants have means to summon help and ability to self-rescue?

  Yes

  No

  N/A

• Are there at least two employees (no one working alone) while in the confined space?

  Yes

  No

  N/A

• Is the rescue plan and all required gear in place?

  Yes

  No

  N/A

• Do the attendees and entrants understand events that could trigger an evacuation or rescue and know how to initiate emergency response?

  Yes

  No

  N/A

Sign off

• Person Conducted Fatal Risk Critical Control Verification.

  Sign