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Ims - 015 Qshe - Confined Space Entry Permit Checklist

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CONFINED SPACE ENTRY PERMIT CHECKLIST

CONFINED SPACE ENTRY PERMIT CHECKLIST YES NO N/A


All manways secured in an open position?
Adequate supply of fresh air available for the duration of entry?
Adequate access and egress provided to manways/entrances?
Is oxy/acetylene equipment required?
(If yes – complete additional requirements information listed below)
Is welding required in the confined space?
(If yes – complete additional requirement information listed below)
Has gas testing been completed? Are levels satisfactory?
Have entry and emergency instructions been given to entrants and manway watcher?
Has the type of adjacent works been considered?
Have combustible materials been removed from the area?
Are fire extinguishers required to be located at access locations?
Are ladders required for internal access?
(If yes – complete additional requirements information listed below)
Are combustion engines a minimum of five (5) metres from ventilation openings?
Are all pipelines, electrical sources, etc. isolated, tagged and witnessed?
Is the type of work being done is likely to cause hazard. E.g. Fume
Is mechanical ventilation required?
Are persons monitor required to be used by entrants?

Additional Requirements/Special Conditions?

Issued By (Signature) Name (Print) Position Date

Accepted By (Signature) Name (Print) Position Date

IMS_015 QSHE CONFINED SPACE ENTRY PERMIT CHECKLIST

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