LOGO
CONFINED SPACE INSPECTION CHECK LIST
Company:
Date of
Area:
Inspection:
Name of Inspector Designation :
IF NO - Corrective
No. Questionnaire Y N NA
Action Taken
1
Section No, 01 HAZARDS EVALUATION AND CONTROL
Does the space contain or potentially contain a hazardous atmosphere?
2 Does the space contain any chemicals or chemical residue?
3 Does the space contain any flammable/combustible substances?
Does the space contain or potentially contain significant amount of
4
decomposing organic matter?
5 Does the space have any pipes which bring chemicals into it?
Does the space have any materials that can trap or potentially trap, engulf,
6
or drown an entrant?
7 Is vision obscured by dust at 5 feet or less?
8 Does the space contain any rotating mechanical equipment?
Does the space have converging walls, sloped or tapered floors to smaller
9 cross-sections which could trap or asphyxiate an entrant (Entrapment
Hazard)?
Does the tank, vessel or equipment in the space contain rusted interior
10
surfaces? (Potential for O2 deficient atmosphere)
11 Does the space contain thermal hazards (e.g., extremely hot or cold)?
12 Does the space have poor illumination levels?
Does the space contain excessive noise levels which could interfere with
13
communication with an attendant?
14 Does the space present any slip, trip, or fall hazards?
Are there any operations conducted or equipment adjacent to the space
15
opening which could present a hazard to entrants?
Are there any hazards from failing objects into the confined space that
16
would necessitate use of barriers?
Are there lines under pressure (compressed air or steam) servicing the
17
space?
18 Are cleaning solvents or paints going to be used in the space?
Is welding, cutting, brazing, riveting, scraping, or sanding going to be
19
performed in the space?
Does the space have energized electrical cables/ equipment or other type
20 of hazardous energy (e.g. steam, compressed gas, rotating mechanical
equipment, etc.) that cannot be locked or tagged out?
Does the space have poor natural ventilation which would allow an
21
atmospheric hazard to develop?
22 Is the entry into a vertical space > 5 feet deep?
Are there any conditions which could prevent any entrants' self-rescue
23
from the space?
24 Are there any substances used in the space which have acute hazards?
Is mechanical ventilation needed to maintain a safe environment? If yes, is
25
it adequate for the volume of the space?
Is air monitoring necessary to ensure the space is safe for entry due to
26
potential hazardous atmosphere?
27 Are residues going to be scraped off the interior surfaces of the vessel?
28 Are non-sparking tools required to remove residues?
29 Is respiratory protection required because of a hazardous atmosphere?)
Does the space present a serious S&H hazard other than those noted
30
above which would make it a permit space?
Section No, 02 HAZARDS EVALUATION AND CONTROL
31 PREPARATION
Has the confined space been evaluated
32 Entry area free of debris and objects
33 Atmospheric monitoring conducted
Constant monitoring required
Periodic; Specify frequency______________
34
Barriers erected around CS opening where personnel could fall into, or
drop objects onto entrants through, a confined space opening
35 All hazards identified and isolated
36 Hot work permit required
37 Energy sources isolated/locked out
38 Forced air or exhaust ventilation equipment
39 Ground fault interrupters (GFCI)
Retrieval Equipment (Not required for hand/arm entries)
40 Retrieval line
Tripod unit (required for vertical spaces > 5’
41 Fire Extinguisher -for welding/burning/hot work
42 Auxiliary lighting
43 Section No, 03 PERSONAL PROTECTIVE EQUIPMENTS
44 Hard Hat
45 Eye/Face Protection
46 Gloves; Specify Type:___________________
47 Safety toe Shoes
48 Protective Clothing
49 Hearing Protection
50 Retrieval Body harness or wristlets (circle)
51 Respirator; Specify Type/cartridge
52 Other: Specify_________________________
For the purposes of this entry:
o All identified hazards have been isolated or eliminated and space is not permit-required.
o The identified hazards will be controlled through continuous forced air ventilation and air monitoring.
o The space is permit-required.
REVIEWED / NOTED BY:
DESIGNATION:
DATE:
