Information
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Confined Space Incident.
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Conducted on:
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Auditor:
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Person being Audited:
Confined Space Task Management
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Are all entry points to the confined space controlled by signage and barricading to prevent entry of persons not involved in the task?
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Has a method to continuously communicate with those in the confined space been established and in place?
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Has a confined space standby person(s) been nominated and is present at all times?
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Has an emergency rescue plan been prepared for the confined space and is available on the job?
CS Training and Competency
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Are you trained and competent to perform confined space activities?
Atmospheric Monitoring
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Has the frequency of atmospheric monitoring within the confined space been determined for atmospheric contaminants and oxygen?
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Is equipment used for monitoring atmospheric conditions in the confined space calibrated and in date?
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Has atmospheric monitoring been completed at the pre-determined frequency and atmospheric conditions are within acceptable levels?
Isolation Confirmation
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Have all hazardous energy sources associated with the task been identified?
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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?
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Have all personnel isolated and applied their personnel lock to all isolation points?
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Have all personnel confirmed they are working on the correct isolated equipment?
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Additional comments/observation
Observation
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Add observations/comments here.
Signatures
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I hereby certify that all information is accurate and that an actual inspection was conducted.
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Auditor's Printed Name & Signature
