MP3 Confined Space Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Name of the Confined Space
  Address

• Personnel Interviewed

Questionnaires

• Is there Confined Space Attendant (CSA) presence at Entry Point?

  Yes

  No

  N/A

• Is there the CSA MP3 2B2 trained?

  Yes

  No

  N/A

• Is there the CSA equipped with entry register and whistle?

  Yes

  No

  N/A

• Is there a valid Entry Permit displayed at the entrance of Confined Space?

  Yes

  No

  N/A

• Is there a clear rescue plan displayed at the entrance of Confined Space?

  Yes

  No

  N/A

• Are there the Confined Space Control safety signs displayed properly?

  Yes

  No

  N/A

• Is the main entrance of the Confined Space free from any obstruction(s)?

  Yes

  No

  N/A

• Is there adequate lighting inside Confined Space?

  Yes

  No

  N/A

• Is there adequate ventilation inside Confined Space?

  Yes

  No

  N/A

• Is there a Gas Meter Carrier (2B2 trained) presence inside Confined Space equipped with portable gas detector?

  Yes

  No

  N/A

• Is there a Fire Watchman deployed with Fire Extinguisher (for hot work activities)?

  Yes

  No

  N/A

• Are the personnel inside Confined Space MP3 2B2 trained?

  Yes

  No

  N/A

• Are the personnel inside Confined Space equipped with Dust Mask and put on while necessary?

  Yes

  No

  N/A

• Are the personnel inside Confined Space equipped with Hearing Protection (Ear Muff / Ear Plug) and put on while necessary?

  Yes

  No

  N/A

• Are the personnel working inside Confined Space aware about Emergency Response procedure?

  Yes

  No

  N/A

Additional Photos

• Additional photos taken during the inspection

  Media

Recommendation by Auditor/Inspector (if any)

Signatures

• Inspected By

  Sign

• Verified By

  Sign

• Noted By

  Sign