HL 1 - CONFINED SPACE ENTRY

• Confined Space Entry

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Confined space

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• Has the tank been vented for 24 hrs

  Yes

  No

  N/A

• Is there adequate ventilation, either forced or natural for the task

  Yes

  No

  N/A

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• Is the risk assessment suitable and sufficient for the task

  Yes

  No

  N/A

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• Has a tollbox talk / JSA been completed and signed off by all personnel on the task

  Yes

  No

  N/A

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• Has a permit to work been raised and signed off by the appropriate responsible person

  Yes

  No

  N/A

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• Are copies of the permit to work available in the correct locations

  Yes

  No

  N/A

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Training

• Are all personnel trained in confined space

  Yes

  No

  N/A

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• Do all personnel know how to raise the alarm and summon help

  Yes

  No

  N/A

• Are the personnel trained in confined space rescue

  Yes

  No

  N/A

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• Are personnel trained in the use of harness, lanyards or restraints

  Yes

  No

  N/A

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• Do all personnel understand how to use the tripod<br>

  Yes

  No

  N/A

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• Are personnel trained in the use of gas testers

  Yes

  No

  N/A

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Testing

• Has the confined space been gas tested

  Yes

  No

  N/A

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• Is the gas tester calibrated and in date

  Yes

  No

  N/A

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• Have personnel gas detectors been issued

  Yes

  No

  N/A

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• Has a personnel gas tester been lowered into the tank prior to entry for the required time

  Yes

  No

  N/A

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• Have the radio's been issued and operationally checked, including specified channel selected

  Yes

  No

  N/A

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Emergency requirements

• Escape set issued

  Yes

  No

  N/A

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• Escape set tested and available in an emergency

  Yes

  No

  N/A

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• Are all personnel wearing suitable harness, lanyards or restraints for the specific task

  Yes

  No

  N/A

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• Tripod set up on entry point

  Yes

  No

  N/A

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• Tank sentry present

  Yes

  No

  N/A

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• Please provide details of the last emergency response practice that has taken place

• Select date

  Date

Signage

• Is there a gas free tag in place

  Yes

  No

  N/A

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• Ample warning signs in place, to warn others of tank entry

  Yes

  No

  N/A

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Other hazards

• Is there suitable lighting for the task

  Yes

  No

  N/A

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• Are all personnel clipped on when entering and exiting.<br>

  Yes

  No

  N/A

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• Is there adequate barriers around the area to prevent other personnel falling or coming into contact with the structure

  Yes

  No

  N/A

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• Are there Mechanical Hazards? If Yes, list.

  Yes

  No

  N/A

• Are there Electrical Hazards? If Yes, list.

  Yes

  No

  N/A

• Are there Heat and/or Cold Safety Concerns? If Yes, Explain.

  Yes

  No

  N/A

• Is there a potential for Reduced Visibility? If Yes, Explain.

  Yes

  No

  N/A

• Is there a Noise Concern? If Yes, Explain.

  Yes

  No

  N/A

• OTHER Hazardous Concern NOT listed?

PPE

• Are all personnel warning the correct PPE for the task and as stated in the risk assessment and toolbox/ JSA

  Yes

  No

  N/A

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