Template Information
Confined space pre-entry checklist
Category: general
Template Questions
- SPACE / EQUIPMENT IDENTIFIER:
- STEP ONE: (If all three are checked, it is a Permitted - Confined Space)
- STEP TWO: (If ANY one hazard is present, it's a "PERMIT-REQUIRED" Confined Space)
- ATMOSPHERIC HAZARDS ......................REQUIRED PPE and/or Equipment.......................RESCUE/ENTRY PROCEDURES
- ENGULFMENT HAZARDS ......................REQUIRED PPE and/or Equipment.......................RESCUE/ENTRY PROCEDURES
- CONFIGURATION HAZARDS ......................REQUIRED PPE and/or Equipment.......................RESCUE/ENTRY PROCEDURES
- OTHER requirement NOT listed:
- OTHER requirement NOT listed?
- OTHER HAZARDS ............................REQUIRED PPE and/or Equipment............................RESCUE/ENTRY PROCEDURES
- OTHER Hazardous Concern NOT listed?
- Photograph of Space #1 OPTIONAL
- Photograph of Space #2 OPTIONAL
- Photograph of Space #3 OPTIONAL
- Photograph of Space #4 OPTIONAL
- SPECIAL REQUIREMENTS FOR NON-PERMITTED SPACES: