Information

  • 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.

Signatures

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

  • Auditor's Printed Name & Signature

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