OHSE 04 - McConnell Dowell - Confined Space

• Document No.

• Audit Title

• Client / Site (displayed on front page)

• Conducted on

  Date

• Prepared by

More than one auditor?

• Additional auditors

• Is the space?

• Enclosed or partially enclosed?

• Likely to be entered and is it at normal atmospheric pressure?

• Have a limited or restricted entry

• Does the space?

• contain, is it intended to contain, or is it likely to contain harmful levels of atmospheric contaminants, or

• contain, is it intended to contain, or is it likely to contain an unsafe oxygen level, or

• contain, is it intended to contain, or is it likely to contain substances that could cause engulfment

• Can the work be conducted in such a way that removes working win a confined space?

  Yes

  No

  N/A

• Has a confined space permit been opened?

  Yes

  No

  N/A

• Has a risk assessment been conducted to determine the risks requiring control? (atmosphere, engulfment, number of persons occupying the space)

  Yes

  No

  N/A

• Is an emergency response plan in place specific to the confined space rescue?

  Yes

  No

  N/A

• Is an emergency response plan known by all workers? (including rescue method and responsibilities)

  Yes

  No

  N/A

• There are no ignition sources within the confined space (smoking, grinding, naked flames, spark generating equipment)

  Yes

  No

  N/A

• If hot works are required, has it been assessed that the hot works are necessary?

  Yes

  No

  N/A

• Persons working in the confined space are trained and certified, (including confined space rescue training)

  Yes

  No

  N/A

• Are all confined spaces clearly sign posted?

  Yes

  No

  N/A
• Add location
  Address

• Signed PoMC Representative:

  Sign
Action required?

• Action

• Action due

  Date

• Allocated to

• Signed Principal Contractor Representative (optional):

  Sign