Lumiform / Templates / Keep workers secure with a confined space entry form

Keep workers secure with a confined space entry form

The confined Space Entry Checklist is a safety checklist used when entering a confined space. It outlines safety measures and protocols to follow, such as ensuring proper ventilation, monitoring the atmosphere, and wearing proper safety gear. It also includes pre-planning steps and checklists for assessing and monitoring the work environment.

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Audit

Pre-operation

Make sure to isolate the space from all hazards.

Remove all unauthorized personnel from the site of entry.

Perform the LOTO procedure.

Make sure to check for any blocking inlets, etc.

Ventilate the space (if necessary).

Fill out the Entry Permit.

Evaluate the confined space.

Test the atmosphere

Fill out the atmosphere readings on the permit.

Make sure to place the completed permit on or nearby the PRCS.

Work In-Progress

Enter the confined space and proceed with work.

Check if the responsible supervisor is available.

Check if the attendant is at the entry site.

Check if the safety harness is utilized

Check if the required PPE is being worn.

Retest the atmosphere as needed or required.

Post operation

Remove all personnel, tools, as well as debris from the space.

Close the space.

Cancel the permit.

Review the procedure with the employer (for hazards, problems, etc.)

File the permit when completed and closed

Recommendations

Enter your recommendations here

Completion

Full Name and Signature of Inspector

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A Confined Space Entry Checklist is a tool used to ensure the safety of personnel who are entering a confined space. It includes a series of steps to be taken before, during, and after entry. These steps include assessing the risk of hazards, assessing the need for specialized equipment, and providing proper training. The checklist also covers emergency protocols, such as calling for assistance and evacuation, as well as post-entry evaluations. By taking the time to complete the checklist carefully, personnel can ensure a safe and successful entry into the confined space.

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.

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