QAL - Critical Control Checklist - Confined Space

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• If 'NO' is selected for any of the controls - Work must stop immediately until the control is in place and verified

CONTROL: A safe atmosphere is verified prior to Confined Space entry and continuously monitored with calibrated equipment Purpose: To maintain a safe atmosphere in confined spaces where workers are present

• Tick "Yes" if applicable

  Yes

  No

  N/A

• Gas monitor is in working order? (Check by; visual inspection, fresh air test and bump testing)

  Yes

  No

  N/A

• Calibration test in date?

  Yes

  No

  N/A

• Testing results included on confined space entry permit?

  Yes

  No

  N/A

• Monitor positioned effectively to detect most probable gas or; Monitor attached to workers (breathing zone)?<br>

  Yes

  No

  N/A

• There is adequate natural and/or forced ventilation?

  Yes

  No

  N/A

CONTROL: Isolation of all gases, liquids and solids with potential to enter the Confined Space Purpose: To prevent introduction of gases, liquids or solids into confined spaces where workers are present

• Tick "Yes" if applicable

  Yes

  No

  N/A

• Approved Isolation instruction has been completed?

  Yes

  No

  N/A

• Isolation hardware / lock board / locks & tags in place?

  Yes

  No

  N/A

• All energy sources de-energised and tested for dead?

  Yes

  No

  N/A

• Workers in the confined space match the confined space permit and isolation instruction sign off?

  Yes

  No

  N/A

• Number of persons in Confined space matches locks and signatures?

  Yes

  No

  N/A

• Inspection completed to verify adequate condition of any valves preventing ingress of substances into the space? (Prior to Confined space entry)

  Yes

  No

  N/A

• Valve Caps (position, arrow and/or colour) indicating valve position?

  Yes

  No

  N/A

CONTROL: Confined Spaces locked and/or secured against inadvertent or unauthorised entry Purpose: To prevent inadvertent / unauthorised entry to confined space

• Tick "Yes" if applicable

  Yes

  No

  N/A

• Chains, locks/padlocks on confined space entry points including gates at fuel tanks/basins?

  Yes

  No

  N/A

• No damage to locks/chains/grating/ access points?

  Yes

  No

  N/A

• Locks and padlocks are locked?

  Yes

  No

  N/A

• Bolted blanks on access openings / spotter in place while space is open?

  Yes

  No

  N/A

• Access to space requires a unique tool

  Yes

  No

  N/A

• Signage indicating confined Space? (similar to image below)

  Yes

  No

  N/A

• 

CONTROL: Emergency Response PURPOSE: To safely and efficiently remove workers from the confined space in the event of an emergency

• Tick "Yes" if applicable

  Yes

  No

  N/A

• Rescue plan identifies; suitable retrieval equipment, first aid equipment?

  Yes

  No

  N/A

• Rehearsed rescue plan / Spotter in place?

  Yes

  No

  N/A

• Effective communication available? (e.g. mobile phone reception)

  Yes

  No

  N/A

• Engineered fixed and portable rescue equipment is in place, fit for purpose and maintained?

  Yes

  No

  N/A

Additional Information

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