Information
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Date / Start Time
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Permit Required (check if YES)
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Observer
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Work Group
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Job Description
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Work Area / Location
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Equipment
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Is there a Permit to Work for the job?
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Do you have an SOP for the Job task?
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Did you share the SOP with the crew prior to performing the job task?
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Has the crew performed this task within the last 6 months?
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% of SSE
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Result
Section 1
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A) How do you know atmospheric conditions are safe for entry? Must answer all that apply.
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* Have the proper monitoring equipment.
* Know how to operate the monitor. (Demonstration)
* Monitor is calibrated and agrees with other monitor(s) used on this job. (Check date)
* Lighting, communication, and other electrical equipment is approved for the Area Classification of the space. -
B) What are acceptable oxygen limits for Confined Space Entry and are they being monitored? Must answer correctly.
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* 19.5% - 23.5%
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C) For LEL’s, H2S, CO, when is it safe to enter and are they being monitored? Must answer correctly.
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* 0% LEL
* < 5 PPM H2S
* < 25 PPM CO -
D) How do you determine what techniques/equipment are used to reduce the hazardous atmospheric conditions?
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* Hazardous atmosphere must be replaced with air that is free of hazards, including those related to temperature.
* How do you determine when ventilation is required?
* Ventilation is required for actual or potential atmospheric hazards and when heat needs to be reduced to a level acceptable for entry.
* How do you verify safe atmospheric conditions?
* Safe conditions must be verified by atmospheric and temperature monitoring.
* NOTE: Industry experts suggest approximately 10 air exchanges per hour.
* Must answer all three questions -
E) How do you verify the IHE for the Confined Space is safe for entry? Must provide all that apply to work being done.
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* Check isolation points using IHE Certificate / Log Sheet or P&ID’s
* Verify isolation with someone who understands the system or the equipment owner.
* Always include gas testing to ensure IHE does not allow introduction of atmospheric hazards. -
F) How have you prepared for rescue of entrants, if that becomes necessary? Must answer all below.
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* Rescue plan is applicable to this entry. (Review)
* Rescue personnel are properly trained for type of rescue that will be required. (Credentials, annual training, annual practice)
* Rescue equipment is appropriate for type of rescue that will be required. (Inspection)
* MSDS for the hazardous substance associated with the space should be available for review by workers, rescuers and responders. -
G) How will heat illness risk be monitored and mitigated? Must provide all that apply to the work being done.
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* Is a temperature monitoring device available?
* Where do you check the temperature?
o Inside the Confined Space
o Outside the Confined Space
* A Heat Illness Prevention Plan must be integrated at what temperature?
o > 850 F
* Entry may not take place above what temperatures inside the Confined Space without ventilation?
o > 1000 F
* At what temperature within the Confined Space must entry be terminated?
o 1100 F -
H) Is an Entry Watch in place, monitoring conditions within the space, and in communication at all times when personnel are in the confined space? Must provide all that apply to work being done.
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* Attendant is present directly outside point of entry.
* Attendant has communication devices if those devices are required.
Section 2
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1) Is the PLW knowledgeable in his/her responsibilities?
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2) Has the PLW verified that the information on the Permit To Work and Specialized Certificates matches the work being performed?
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3) Are non-confined space alternatives considered prior to performing an entry?
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4) Is the SEE-IT-WHEEL utilized to identify all hazards associated with CSE, including those that require positive physical isolation? (Not a requirement, but a recommendation)
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5) Does the Entry Watch maintain an Entry Log: Name, Time in, Due out, Time out?
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6) Is there a method in place to ensure clear communication between entrants and attendants during the CSE?
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7) Is the confined space secured to preclude entry when left unattended?
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8) Are flammable gas sources removed before leaving the confined space unattended?
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9) Has proper training been provided to all CSE Supervisors, Entrants, Attendants and Rescuers?
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10) Was site hazard identification/recognition discussed with the crew?
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Hazards discussed/identified with crew
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Comments/Nuggets
