Confined Space Safety Checklist

Use the following checklist to evaluate the confined space.

DO NOT ENTER A CONFINED SPACE UNTIL YOU HAVE CONSIDERED EVERY QUESTION, AND HAVE DETERMINED THE SPACE TO BE SAFE.

YES	NO
		Is entry necessary?

YES	NO	TESTING
		Are the instruments used in atmospheric testing properly calibrated?
		Was the atmosphere in the confined space tested?
		Was Oxygen at least 19.5% - not more than 21%?
		Were toxic, flammable, or oxygen-displacing gases/vapors present?

Which of the following gases are identified?
Hydrogen Sulfide
Carbon Monoxide
Methane
Carbon Dioxide
Other (list)

YES	NO	MONITORING
		Will the atmosphere in the space be monitored while work is going on?
		Continuously?
		Periodically?
		(If yes, give interval: ................)

REMEMBER - ATMOSPHERIC CHANGES OCCUR DUE TO THE WORK PROCEDURE OR THE PRODUCT STORED. THE ATMOSPHERE MAY BE SAFE WHEN YOU ENTER, BUT CAN CHANGE VERY QUICKLY.

YES	NO	CLEANING
		Has the space been cleaned before entry is made?
		Was the space steamed?
		If so, was it allowed for cooling?

YES	NO	VENTILATION
		Has the space been ventilated before entry?
		Will ventilation be continued during entry?
		Is the air intake for the ventilation system located in an area that is free of combustible dust and vapors and toxic substances?
		If the atmosphere was found unacceptable and then ventilated, was it re-tested before entry?

YES	NO	ISOLATION
		Has the space been isolated from other systems?
		Has electrical equipment been locked out?
		Have disconnects been used where possible?
		Has mechanical equipment been blocked, chocked, and disengaged where necessary?
		Have lines under pressure been blanked and bled?

YES	NO	CLOTHING/EQUIPMENT
		Is special clothing required (boots, chemical suits, glasses. etc.)? (If so, specify:............... )
		Is special equipment required (e.g. rescue equipment. communications equipment, etc.)? (If so, specify: ..........................................)
		Are special tools required (e.g., spark-proof)? (If so, specify:.................................. )

YES	NO	RESPIRATORY PROTECTION
		Are approved respirators of the type required available at the worksite?
		Is respiratory protection required (e.g., air-purifying, supplied-air, self-contained breathing apparatus. etc.)? (If so, specify type:..................................... )
		Can you get through the opening with a respirator on? (If you don’t know, find out before you try to enter.)

YES	NO	TRAINING
		Have you been trained in the proper use of a respirator?
		Have you received first aid/CPR training?
		Have you been trained in confined space entry and do you know what to look for?

YES	NO	STANDBY/RESCUE
		Will there be a standby person on the outside for constant visual or auditory communication with the person inside?
		Will the standby person be able to see and/or hear the person inside at all times?
		Has the standby person(s) been trained in rescue procedures?
		Will safety lines and harness be required to remove a person?
		Are company rescue procedures available to be followed in the event of an emergency?
		Are you familiar with emergency rescue procedures?
		Do you know who to notify and how in the event of an emergency?

YES	NO	PERMIT
		Has a confined space entry permit been issued?
		Does the permit include a list of emergency telephone numbers?

The permit is an authorization in writing that states that space has been tested by a qualified person, that the space is safe for entry; what precautions, equipment, etc. are required; and what work is to be done.

For further information on confined spaces, occupational hazards, safe work practices, and other topics which could affect your well-being, write to or consult to chief inspector of factories of your state.