Pre-Task: Confined Space Checklist (Entry Briefing)

Audit

Confined Space Details

Project / Site Name

A confined space means an enclosed or partially enclosed space that is not designed for continuous occupancy. A confined space requires a permit (in relevant jurisdictions) if a space may also: contain a hazardous atmosphere; contain material that has the potential to engulf an entrant; has walls that converge inward or floors that slope downward and taper into a smaller area which could trap or asphyxiate an entrant; or contains any other recognized safety or health hazard, such as unguarded machinery, exposed live wires, or heat stress.

Is a permit required for this space?

Is a permit currently valid for the confined space?

Permit issued to

Date and time of entry

Description of work

Location

Specific Location on site

Identify potential hazards of this confined space? (select all that apply)

Describe other hazard(s)

Preparation

Space ventilated to full extent possible?

All people involved have completed confined space training?

Vehicles and plants removed from confined space to reduce fume hazard? If not, have precautions been put in place?

Correct confined space signage in place?

Space lighting in place and appropriate?

Access (both entry and exit) points have been identified and are clear of hazards for use?

Communications plan defined and understood by all involved?

Select methods of communication to be adopted (select all that apply)
Air Monitoring

Does the air of this confined space require monitoring?

Is the air of the confined space being continuously monitored? (as required)

Log air sample results
Time of sample

Sample result

Is this sample within acceptable parameters? Should confined space work proceed?

Has air monitoring equipment been calibrated?

Safety Equipment & PPE
Select equipment to be used in this confined space entry

Describe other equipment

Select PPE to be used in this confined space entry

Describe other PPE

Rescue & Emergency Plan

Emergency evacuation and rescue plan is complete, in place and understood by all employees?

Emergency Number

Location of phone or radio

Emergency actions to be taken

Potential emergency situations

Team Sign Off

Have all relevant personnel participated in pre-entry briefing?

Confined Space Entrants: We (I) have reviewed the potential emergency situations and actions to be taken. We (I) are familiar with all rescue equipment and communication methods. I have been formally trained in confined space entry.
Name and Signature (entrant to sign)
Confined Space Entry Supervisor: I have complete properly evaluated this confined space and verified that acceptable entry conditions exist. All personnel have reviewed the conditions of the entry and are adequately trained to perform this task. I have been formally trained in confined space entry.
Name and Signature (supervisor to sign)

Pre-task: Confined Space Checklist (entry Briefing)

This confined space checklist is a pre-start safety check for permit required confined space works in construction.

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Audit

Confined Space Details

Project / Site Name

A confined space means an enclosed or partially enclosed space that is not designed for continuous occupancy. A confined space requires a permit (in relevant jurisdictions) if a space may also: contain a hazardous atmosphere; contain material that has the potential to engulf an entrant; has walls that converge inward or floors that slope downward and taper into a smaller area which could trap or asphyxiate an entrant; or contains any other recognized safety or health hazard, such as unguarded machinery, exposed live wires, or heat stress.

Is a permit required for this space?

Is a permit currently valid for the confined space?

Permit issued to

Date and time of entry

Description of work

Location

Specific Location on site

Identify potential hazards of this confined space? (select all that apply)

Describe other hazard(s)

Preparation

Space ventilated to full extent possible?

All people involved have completed confined space training?

Vehicles and plants removed from confined space to reduce fume hazard? If not, have precautions been put in place?

Correct confined space signage in place?

Space lighting in place and appropriate?

Access (both entry and exit) points have been identified and are clear of hazards for use?

Communications plan defined and understood by all involved?

Select methods of communication to be adopted (select all that apply)
Air Monitoring

Does the air of this confined space require monitoring?

Is the air of the confined space being continuously monitored? (as required)

Log air sample results
Time of sample

Sample result

Is this sample within acceptable parameters? Should confined space work proceed?

Has air monitoring equipment been calibrated?

Safety Equipment & PPE
Select equipment to be used in this confined space entry

Describe other equipment

Select PPE to be used in this confined space entry

Describe other PPE

Rescue & Emergency Plan

Emergency evacuation and rescue plan is complete, in place and understood by all employees?

Emergency Number

Location of phone or radio

Emergency actions to be taken

Potential emergency situations

Team Sign Off

Have all relevant personnel participated in pre-entry briefing?

Confined Space Entrants: We (I) have reviewed the potential emergency situations and actions to be taken. We (I) are familiar with all rescue equipment and communication methods. I have been formally trained in confined space entry.
Name and Signature (entrant to sign)
Confined Space Entry Supervisor: I have complete properly evaluated this confined space and verified that acceptable entry conditions exist. All personnel have reviewed the conditions of the entry and are adequately trained to perform this task. I have been formally trained in confined space entry.
Name and Signature (supervisor to sign)