Prepared: A.

Aitouche IPM
IPMIRAQ
IRAQ IPM-IRAQ-HSE-006

Reviewed: Arbil Boz Confined

Confined
Confined SSpace
Confined
pace Entry
Space Entry
Entry Rev 1.0 Page: 9 of 10
Approved: Gokhan Aker Space
Procedure
Procedure Issued: May 2013
Procedure

Appendix 1

CONFINED
SPACE
Questionnaire SAFETY Yes No N/A
CHECKLIST
1. Is the confined space empty of any hazardous substances?
Complete this
2. Are all impellers, agitators and other moving
checklist that may be a hazard locked? out and
parts
secured according to the LOTO procedure? before entry
3. Is either natural or mechanical ventilation into any
provided?
confined space
4. Have the appropriate atmosphere tests been performed?
and prior to a
4.1 Oxygen deficiency checked? request for a
4.2 Combustible substance checked? Permit to
Work.
4.3 Toxic substance checked?
5. Is the confined space hazard classified or zoned?
6. Has safe illumination been provided?
7. Have arrangements been made for continuous monitoring of the atmosphere inside the space?
8. Has a standby person(s) been assigned whose only responsibility is to watch the work in
progress, sound an alarm and provide assistance?
9. Has the assigned person been trained and equipped to handle an emergency?
10. Is the required respiratory equipment available and been checked?
11. has all electrical equipment to be used inside the space been grounded, insulated and/or is
equipped with ground fault protection?
12. If any hot work is to be done inside the space, have the hoses been checked for leaks, gas
bottles secured outside the confined space, and atmosphere tested prior to entry?
13. If there is any oxygen consuming equipment to be used, has sufficient air been provided to
assure oxygen content will remain above 19.5%?
14. If combustion equipment is to be used, are exhausts vented outside?
15. Has the space been checked for decaying wastes, which could produce methane gas, or that
there are no signs of hazardous waste?
16. Has the entry person been trained on the PPE and confined space?
17. Has the entry person been instructed on the potential hazards?

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File with Permit to Work during the job.
Describe the
confined space
& date of job

Person
completing
checklist &
date
Page 9 of 10