TVA - CONFINED SPACE ENTRY PROGRAM SELF ASSESSMENT CHECKLIST

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• PLANT or FACILITY:

• UNIT# / LOCATION / EQUIPMENT ID:

GENERAL REQUIREMENTS FOR ENTRY INTO PERMIT SPACES

• Has the workplace been formally evaluated to determine if any confined spaces exist?

  Yes

  No

  N/A

• Are all confined spaces listed in the site Confined Space Inventory & Evaluation Form?

  Yes

  No

  N/A

• For each space listed on the Inventory, are hazards identified and evaluated and has a Confined Space Evaluation Report verified and then eliminated or controlled?

  Yes

  No

  N/A

• Prior to entry, are the hazards listed on the Evaluation Report verified and then eliminated or controlled?

  Yes

  No

  N/A

• Have exposed employees been informed of the existence and dangers posed by confined spaces on site?

  Yes

  No

  N/A

• Are confined spaces, which can be readily entered, identified by danger signs, or by any other equally effective means? (Confined spaces such as piping systems or man-ways with multiple bolts may not necessarily require such signs).

  Yes

  No

  N/A

• If employees will not enter confined spaces, have effective measures been taken to prevent entry?

  Yes

  No

  N/A

• Are the means, procedures, and practices necessary for safe permit space entry operations developed and implemented?

  Yes

  No

  N/A

REVIEW OF COMPLETED ENTRY PERMITS

• Was a rescue plan specified and described on the permit?

  Yes

  No

  N/A

• Were means for summoning rescue identified and functionally tested?

  Yes

  No

  N/A

• Was rescue IN USE? (Non-entry retrieval set up with a trained attendant or entry rescue equipment staged at the entry portal?)

  Yes

  No

  N/A

• Were enough rescuers available for the entry operation?

  Yes

  No

  N/A

• Did the rescue team Pre-plan the Permit Space?

  Yes

  No

  N/A

• Were acceptable entry conditions specified?

  Yes

  No

  N/A

• Were engineering and work practice controls specified?

  Yes

  No

  N/A

• Was PPE properly specified for the hazards present?

  Yes

  No

  N/A

• If respiratory protection was specified, was ventilation in use to minimize the atmospheric hazard(s)?

  Yes

  No

  N/A

• Was the atmospheric monitoring data readily available for review by employees (evidence of posting)

  Yes

  No

  N/A

• If an initial entry is required to obtain the data above, is the entry made under the written permit space program?

  Yes

  No

  N/A

• Has the Entry Supervisor and Atmospheric Evaluator properly evaluated all of the hazards of the space? Are 'eliminated' hazards truly isolated?

  Yes

  No

  N/A

• Other than atmospheric, are hazards listed on the Evaluation Report that are not eliminated?

  Yes

  No

  N/A

• Once the entrance is removed, is the opening protected by a railing, temporary cover, or barrier that will prevent an accidental fall through the opening and will protect each employee working in the space from foreign objects entering the space?

  Yes

  No

  N/A

• Prior to an employee entering the space, is the internal atmosphere tested with a calibrated direct reading instrument?

  Yes

  No

  N/A

• Is monitoring done in the following order: Oxygen content, Flammable gases and vapors, and then potential toxic air contaminants?

  Yes

  No

  N/A

• When the employee enters the space, is the atmosphere inside of the space free from all contaminants?

  Yes

  No

  N/A

• Is natural or continuous forced air ventilation alone sufficient to maintain the space safe for entry?

  Yes

  No

  N/A

• Is the atmosphere inside of the space periodically tested, as necessary, to ensure that natural or continuous forced air ventilation is preventing the accumulation of a hazardous atmosphere?

  Yes

  No

  N/A

• IF CONTINUOUS FORCED AIR VENTILATION IS USED:

• ~ Has the continuous forced air ventilation eliminated any hazardous atmosphere before an employee enters the space?

  Yes

  No

  N/A

• ~ Is the continuous forced air ventilation so directed as to ventilate the immediate areas where an employee is or will be present within the space?

  Yes

  No

  N/A

• ~ Is the forced air ventilation continued until all employees have left the space?

  Yes

  No

  N/A

• ~ Is the air supply for the forced air ventilation from a clean source that does not increase the hazards in the space?

  Yes

  No

  N/A

• IF A HAZARDOUS ATMOSPHERE IS DETECTED DURING THE ENTRY:

• ~ Do all the employees exit the space immediately?

  Yes

  No

  N/A

• ~ Is the space evaluated to determine how the hazardous atmosphere developed?

  Yes

  No

  N/A

• ~ Are measures implemented to protect employees from the hazardous atmosphere before any subsequent entry takes place?

  Yes

  No

  N/A

• ~ Is the space verified safe for entry, using a written certification form?

  Yes

  No

  N/A

• ~ Is the Confined Space Evaluation Report completed prior to entry?

  Yes

  No

  N/A

• ~ Does the Confined Space Evaluation Report contain the date, the location of the space, and the signature of the person providing the certification?

  Yes

  No

  N/A

• ~ Is the Confined Apace Evaluation Report made available to each employee entering the space?

  Yes

  No

  N/A

NON-PERMIT ENTRY

• If there are changes in the use or configuration of a non-permit required confined space that might increase the hazards to entrants, are the spaces re-evaluated and, if necessary, reclassified as permit required confined space?

  Yes

  No

  N/A

• Do any of the non-permit confined spaces pose any actual or potential atmospheric or physical hazards?

  Yes

  No

  N/A

• If it is necessary to enter the space to eliminate hazards, is the entry initially made under the permit required program?

  Yes

  No

  N/A

• Is written certification via Hazard Evaluation Report available listing the basis for determining that all hazards in a permit space have been eliminated if it was down-graded to a non-permit required confined space?

  Yes

  No

  N/A

• Is the Hazard evaluation Report posted at the entry portal for a Non-permit space and available to each employee entering the space?

  Yes

  No

  N/A

• If hazards arise in a space that has been reclassified as a non-permit required confined space, do all employees exit the space?

  Yes

  No

  N/A

• If a non-permit required confined space has to be evacuated, is the space re-evaluated to determine whether it must be reclassified as a permit - required confined space?

  Yes

  No

  N/A

CONTRACTOR ENTRY

• Are measures in place that will prevent unauthorized entry into confined spaces supplier/contract personnel?

  Yes

  No

  N/A

• Have suppliers/contractors been informed that the workplace contained confined spaces, and that confined space entry is allowed only through compliance with the site's written Confined Space Entry Program or equivalent?

  Yes

  No

  N/A

• Does the contractor obtain any available information regarding confined space hazards and entry operations from the job sponsor or site?

  Yes

  No

  N/A

• Has the contractor been apprised of the elements, including the hazards identified and historical experience with the space that makes the space a permit space?

  Yes

  No

  N/A

• Has the contractor been apprised of any precautions or procedures that have been implemented for the protection of employees in or near the confined space where the contractor personnel will be working?

  Yes

  No

  N/A

• Has the contractor demonstrated that the contractor personnel, that will be expected to enter confined spaces, have been properly trained?

  Yes

  No

  N/A

• Are entry operations coordinated with the contractor, when both site employees and contract personnel will be working in or near confined spaces?

  Yes

  No

  N/A

• Does the contractor coordinate entry operations with the job sponsor, when both the site personnel and contractor personnel will be working in or near a confined space?

  Yes

  No

  N/A

• If applicable, does the contractor inform and allow the job sponsors to review the Confined Space Entry Program that the contractor will follow (if different) and of any hazards confronted or created in permit spaces, either through a job planning, Pre-job Briefing, during the entry operations, or during a job debriefing?

  Yes

  No

  N/A

• Is the contractor debriefed at the conclusion of the entry operation regarding the Confined Space Entry Program that was followed and questioned regarding any hazards confronted or created in permit spaces during entry operations?

  Yes

  No

  N/A

CONFINED SPACE REACUE

• Are procedures developed and implemented for summoning rescue and emergency services?

  Yes

  No

  N/A

• Are procedures developed and implemented for rescuing entrants from Permit Required Confined Spaces, and for providing necessary emergency services to rescue employees?

  Yes

  No

  N/A

• Are procedures developed and implemented that prevent unauthorized personnel from attempting rescue?

  Yes

  No

  N/A

• Is a system developed and implemented for the preparation, issuance, use, and cancellation of entry permits?

  Yes

  No

  N/A

• Has the outside service been evaluated as to it's ability, qualifications, equipment and willingness to provide the needed response?

  Yes

  No

  N/A

• Is the evaluation documented and on file as part of the site's written Confined Space Program?

  Yes

  No

  N/A

• Has the outside service visited the plant during the past year, made aware of the types of spaces they may have to enter to perform a rescue, and given the opportunity to practice rescue techniques at the plant?

  Yes

  No

  N/A

ACTIVE CONFINED SPACE ENTRY OBSERVATION

• ( Two active confined space entries to be selected and observed for evaluation. )

• Is the space clearly identified as a Permit Required Confined Space?

  Yes

  No

  N/A

• Is a Confined Space Permit posted at the access? (if more than one access, are copies posted at each, and are sufficient means employed to prevent unauthorized entry?)

  Yes

  No

  N/A

• Is atmospheric monitoring being conducted in the space? If an air monitor is being used, is it being used correctly?

  Yes

  No

  N/A

• Are the conditions in the permit space verified to be acceptable for the entry, throughout the duration of an authorized entry?

  Yes

  No

  N/A

• Is the Entry Permit current? (Verify using the time constraints identified on the Entry Permit.)

  Yes

  No

  N/A

• Are spaces isolated?

  Yes

  No

  N/A

• Are atmospheric hazards controlled or eliminated by purging, flushing, or through ventilation?

  Yes

  No

  N/A

• Are work process on-going in the space listed on the Entry Permit?

  Yes

  No

  N/A

• ARE PERMIT SPACE CONDITIONS EVALUATED AS FOLLOWS WHEN ENTRY OPERATIONS ARE CONDUCTED?

• ~ Test conditions in the permit space to determine if acceptable entry conditions exist before entry is authorized to begin?

  Yes

  No

  N/A

• ~ Test or monitor the permit space, as necessary, to determine if acceptable entry conditions are being maintained during the course of entry operations?

  Yes

  No

  N/A

• ~ Has permission been granted to enter the space by an Entry Supervisor? (Verify signature.)

  Yes

  No

  N/A

• ~ Are all protective measures being utilized, as identified on the Entry Permit?

  Yes

  No

  N/A

• ~ Do the protective measures provide adequate protection of entrants?

  Yes

  No

  N/A

• ~ Is access / egress adequate?

  Yes

  No

  N/A

• ~ Is the access point unobstructed?

  Yes

  No

  N/A

• ~ Is lighting adequate?

  Yes

  No

  N/A

• ~ Is communication adequate?

  Yes

  No

  N/A

• ~ Is ventilation adequate?

  Yes

  No

  N/A

• ~ Are all employees in the space appropriately logged in?

  Yes

  No

  N/A

• ~ Is at least one authorized attendant provided outside the permit space, into which entry is authorized, for the duration of entry operations?

  Yes

  No

  N/A

• ~ Are good housekeeping practices being observed?

  Yes

  No

  N/A

• ~ Is the area free from on-going work processes that may create hazards to employees in the space?

  Yes

  No

  N/A

• ~ Where applicable, is emergency rescue equipment available at entrance?

  Yes

  No

  N/A

• ~ Where utilized, are lifelines attached to a substantial structure?

  Yes

  No

  N/A

• ~ Where needed, are adequate controls (e.g. barricades, ropes, warning tapes and/or signs) being utilized?

  Yes

  No

  N/A

• ~ Does the location of emergency equipment correspond to what is entered on the Entry Permit? (Physically verify.)

  Yes

  No

  N/A

• ~ Does the location of the nearest phone (if applicable) correspond to what is entered on the Entry Permit? (Physically verify.)

  Yes

  No

  N/A

• ~ Does the phone or radio being used for emergency purposes work properly? (Physically verify.)

  Yes

  No

  N/A

• ~ Have Entrants read the (or had explained to them) the Confined Space Permit and it's requirements?

  Yes

  No

  N/A

• ~ Do they understand the existing / potential hazards associated with the space?

  Yes

  No

  N/A

• ~ Do they understand the protective measures?

  Yes

  No

  N/A

• ~ Are the protective measures being utilized?

  Yes

  No

  N/A

• ~ Is the Entry Supervisor accessible? (Verify by use of phone or radio to contact.)

  Yes

  No

  N/A

• ~ Are other permits or documentation (Hot Work, MSDS, etc.) available at the space, as identified on the Entry Permit?

  Yes

  No

  N/A

• ~ If the work activity involves welding, are special considerations being followed, such as ventilation and respirator use?

  Yes

  No

  N/A

• ~ Are entrants/welders using a full body harness and lifeline to enhance rescue?

  Yes

  No

  N/A

• ~ Is a tripod or other device in place to promote non-entry rescue by the attendant or personnel outside the space?

  Yes

  No

  N/A

• ~ Is forced ventilation established to prevent the accumulation of toxic materials or possible oxygen deficiency?

  Yes

  No

  N/A

• ~ Is the monitoring frequency consistent with what is identified on the Entry Permit?

  Yes

  No

  N/A

• ~ Have the instruments being used for atmospheric testing been calibrated? (Use instrument ID# to verify.)

  Yes

  No

  N/A

• ~ Are all compensatory measures, as identified on the Entry Permit, in use?

  Yes

  No

  N/A

• ~ Are identified measures appropriate for the hazards encountered within the space?

  Yes

  No

  N/A

• ~ Is the current Attendant identified on either the Entry Permit or Supplemental Log sheet?

  Yes

  No

  N/A

• ~ Has the Attendant been properly trained in their roles and responsibilities?

  Yes

  No

  N/A

• ~ Has a copy of the Entry Permit been delivered to Operations?

  Yes

  No

  N/A

• ~ Does a Confined Space Hazard Evaluation Report exist for the space name and location?

  Yes

  No

  N/A

• ~ Are all persons involved with the entry process properly trained (I.e. entrants, attendants, authorizing person, HA?) (Verify by training records.)

  Yes

  No

  N/A

• ~ Do the employees working in the in the spaces demonstrate understanding of the Confined Space Entry Program?

  Yes

  No

  N/A

ORGANIZATIONAL EFFECTIVENESS

• This section can be used to evaluate how well the Confined Space Entry Program is implemented and properly supported by management. Focus should be on process issues, not compliance.

• Does a process ensure that corrective actions are developed and implemented for deficiencies identified during program evaluations or incident investigations are implemented, documented, and communicated to management?

  Yes

  No

  N/A

• Does a process ensure that confined spaces are adequately evaluated and made safe prior to entry?

  Yes

  No

  N/A

• Does a process ensure that air monitors used in confined spaces are calibrated and bump tested as required by the manufacture?

  Yes

  No

  N/A

• DOES A PROCESS ENSURE THAT CONTRACTORS ARE INFORMED OF THE:

• ~ Hazards associated with the confined entry space job?

  Yes

  No

  N/A

• ~ Applicable confined space entry program?

  Yes

  No

  N/A

• ~ Applicable emergency procedures for confined space entries?

  Yes

  No

  N/A

• Does a process ensure that contract employees have been trained for confined space entry?

  Yes

  No

  N/A

• DOES A PROCESS EXIST TO ENSURE THE FOLLOWING PERSONNEL BEEN IDENTIFIED AND TRAINED IN THEIR ROLES AND RESPONSIBILITIES REGARSING CONFINED SPACES?

• ~ Entrant

  Yes

  No

  N/A

• ~ Attendant

  Yes

  No

  N/A

• ~ Authorized Person

  Yes

  No

  N/A

• ~ Authorized Hazard Analyzer

  Yes

  No

  N/A

• ~ Other affected personnel

  Yes

  No

  N/A

• Have the appropriate individuals, I.e., those most familiar with the work processes to be performed during the entry, been selected to serve as Entry Supervisors?

  Yes

  No

  N/A

• Does a process ensure that outside rescue services are kept aware of the types of confined spaces, and their hazards, in which they may be called upon to perform a confined space rescue?

  Yes

  No

  N/A

• Are outside rescue services that have been designated to perform, or provide support for, confined space rescue given the opportunity to train on these spaces at the plant?

  Yes

  No

  N/A