Information

  • Field:

  • Location:

  • Conducted on

  • Time:

  • Prepared by

  • Pre-entry planning was conducted to review work scope, permit requirements, LOTO requirements, ventilation techniques, and rescue plan?

  • Personnel involved have conducted a task specific hazard analysis prior to beginning confined space activities?

  • All energy sources have been properly identified and isolated in accordance with the Energy Isolation or Opening and Blinding Standard?

  • All lines connecting to the confined space are physically disconnected and misaligned or blinded as close to the work or confined space as possible?

  • All personnel affected by the energy isolation have walked down the isolation, installed personal locks, and signed in to the Energy Isolation Master Card?

  • Prior to opening the space atmospheric monitoring has been conducted to verify <50% LEL?

  • 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"?

  • Is the opening of the spaced protected adequately to prevent unauthorized or inadvertant entry?

  • Prior to permit authorization atmospheric monitoring has been conducted with ventilation at rest (shut off) and documented adequately on the CSE permit?

  • The frequency of atmospheric monitoring is identified on the CSE permit and is being conducted and documented on the permit?

  • Appropriate safety/operations considerations are documented on the CSE permit and have been verified as completed prior to authorizing entry to the confined space?

  • All entrants identified on the CSE permit and entry and exit times to and from the space documented accurately?

  • Adequate means of communication is available and onsite? All parties involved in the CSE operation understand communication protocols for the entry?

  • 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?

  • Adequate lighting in the confined space? Is lighting intrinsically safe if used in an envrionment that has the potential to have flammable vapors?

  • 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)?

  • Rescue Plan / Services are available and rescue plan has been reviewed by operations and rescue personnel?

  • Retrieval systems are used whenever an entrant enters a confined space unless the retrieval system would increase the hazard?

  • Confined space has been classified correctly (non-regulated vs regulated) and the permit has been completed correctly?

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.