• Confined Space Incident.

  • Conducted on:

  • Auditor:

  • Person being Audited:

Confined Space Task Management

  • Are all entry points to the confined space controlled by signage and barricading to prevent entry of persons not involved in the task?

  • Has a method to continuously communicate with those in the confined space been established and in place?

  • Has a confined space standby person(s) been nominated and is present at all times?

  • Has an emergency rescue plan been prepared for the confined space and is available on the job?

CS Training and Competency

  • Are you trained and competent to perform confined space activities?

Atmospheric Monitoring

  • Has the frequency of atmospheric monitoring within the confined space been determined for atmospheric contaminants and oxygen?

  • Is equipment used for monitoring atmospheric conditions in the confined space calibrated and in date?

  • Has atmospheric monitoring been completed at the pre-determined frequency and atmospheric conditions are within acceptable levels?

Isolation Confirmation

  • Have all hazardous energy sources associated with the task been identified?

  • Have all energy sources been contained / de-energised and a try test been completed to confirm the integrity of the isolation and ensure a zero energy state?

  • Have all personnel isolated and applied their personnel lock to all isolation points?

  • Have all personnel confirmed they are working on the correct isolated equipment?

  • Additional comments/observation

  • Observation
  • Add observations/comments here.


  • I hereby certify that all information is accurate and that an actual inspection was conducted.

  • Auditor's Printed Name & Signature

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.