Information
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Field:
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Location:
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Conducted on
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Time:
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Prepared by
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Pre-entry planning was conducted to review work scope, permit requirements, LOTO requirements, ventilation techniques, and rescue plan?
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Personnel involved have conducted a task specific hazard analysis prior to beginning confined space activities?
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All energy sources have been properly identified and isolated in accordance with the Energy Isolation or Opening and Blinding Standard?
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All lines connecting to the confined space are physically disconnected and misaligned or blinded as close to the work or confined space as possible?
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All personnel affected by the energy isolation have walked down the isolation, installed personal locks, and signed in to the Energy Isolation Master Card?
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Prior to opening the space atmospheric monitoring has been conducted to verify <50% LEL?
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If the confined space is opened is it identified with a sign on the outside of the space that reads "Danger - Confiend Space - Enter by Permit Only"?
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Is the opening of the spaced protected adequately to prevent unauthorized or inadvertant entry?
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Prior to permit authorization atmospheric monitoring has been conducted with ventilation at rest (shut off) and documented adequately on the CSE permit?
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The frequency of atmospheric monitoring is identified on the CSE permit and is being conducted and documented on the permit?
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Appropriate safety/operations considerations are documented on the CSE permit and have been verified as completed prior to authorizing entry to the confined space?
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All entrants identified on the CSE permit and entry and exit times to and from the space documented accurately?
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Adequate means of communication is available and onsite? All parties involved in the CSE operation understand communication protocols for the entry?
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Adequate ventilation is maintained during entry operations? Mechanical ventilation is bonded/grounded? Ventilation is set up to prevent toxic contaminants from entering the confined space?
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Adequate lighting in the confined space? Is lighting intrinsically safe if used in an envrionment that has the potential to have flammable vapors?
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If welding / cutting is required are the electrodes and / or hoses removed from the confined space when not in use (such as a lunch break)?
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Rescue Plan / Services are available and rescue plan has been reviewed by operations and rescue personnel?
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Retrieval systems are used whenever an entrant enters a confined space unless the retrieval system would increase the hazard?
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Confined space has been classified correctly (non-regulated vs regulated) and the permit has been completed correctly?