Restricted Space Job Audit

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location

  Sonoco Birmingham

• What is the name of the restricted space

• Take a photo of the restricted space

  Media

• Is the space posted with an identification placard place at the entrance of the restricted space?

  Yes

  No

• Notify the program administrator

• Take a photo of the identification placard

  Media

• Work to be performed?

• Name of the entrant(s)?

• Name of the attendant?

Authorization form

• Did the worker check that the identification placard corresponded to the equipment and targeted work?

  Yes

  No

• Was the name of the equipment specified on the authorization form?

  Yes

  No

• Was the date specified?

  Yes

  No

• Was the nature of the work specified and does it correspond to the authorized tasks?

  Yes

  No

Preventive Measures

• Were the preventive measures stipulated on the authorization form respected?

  Yes

  No

• Check if apply

  Select Lockout performed Harness worn Safety perimeter set up Monitoring on site

  • Lockout performed
  • Harness worn
  • Safety perimeter set up
  • Monitoring on site

• Why the procedure have not been followed?

• Were the precautions to take checked when “applied”?

  Yes

  No

• Was the start time recorded?

  Yes

  No

Entrant

• Was the name of the entrant specified in the appropriate place?

  Yes

  No

• Did the entrant sign the authorization form in the designated place?

  Yes

  No

• Did the entrant receive training and is he qualified?

  Yes

  No

• Notify the immediate supervisor

Attendant

• Was the name of the attendant specified in the designated place?

  Yes

  No

• Did the attendant sign the authorization form in the designated place?

  Yes

  No

• Was monitoring done throughout the work period?

  Yes

  No

• Why ?

• Did the attendant remain in visual, auditory or other type of communication with the entrant?

  Yes

  No

• Check if apply

  Visual

  Auditory

  Other type

• What is the type of communication exactly?

• Did the attendant receive training and is he qualified?

  Yes

  No

• Notify the immediate supervisor

• Does the attendant know the steps to follow in the event of an emergency?

  Yes

  No

• Take a photo of the filled authorization form

  Media

End of Work

• Was the end time recorded?

  Yes

  No

• Was the restricted space decommissioned?

  Yes

  No

• Was the form returned for archiving purposes in the designated place when the sheet was full?

  Yes

  No