Anonymous

USSW Non Permit Confined Space Pre-Entry Checklist V1

The following checklist and a continuous air monitoring log needs to be completed prior to work beginning and when work is resumed in an area that meets these criteria

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Title Page

Site conducted
Conducted on (Date and Time)
Prepared by

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Did your survey of the surrounding area show it to be free of hazards such as drifting vapors from tanks,piping or sewers?
Does your knowledge of industrial or other discharges indicate this area is likely to remain free of dangerous air contaminates while occupied?
Are you competent in the operation of the gas monitor to be used?
Has a gas monitor functional test (bump test) been performed this shift on the gas monitor to be used?
Did you test the atmosphere of the confined space prior to entry?
Did the atmosphere check as acceptable ( no alarms given) ?
Will the atmosphere be continuously monitored while the space is occupied?
Have the proper control measures (mechanical ventilation) been installed to eliminate a potentially hazardous atmosphere?
Have the applicable SDS sheets for products being used been reviewed by all who are to be occupying the space?

Anonymous

USSW Non Permit Confined Space Pre-Entry Checklist V1

The following checklist and a continuous air monitoring log needs to be completed prior to work beginning and when work is resumed in an area that meets these criteria

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.