CONFINED SPACE ACTIVITIES CHECKLIST

Completed by/
Date/

Location/ PA Name/
Company/

Item/
Description / Yes/ No/ NA Comments/

Has the “CONFINED SPACE ENTRY CHECKLIST” been

1. completed and signed prior to start of work activity?

Are PERSONS entering/exiting the confined space properly

2. REGISTERED in the “Confined Space Entry Log”?

Is the EMERGENCY RESCUE PLAN attached to PTW?

3.

Is suitable & sufficient RESCUE & SAFETY

EQUIPMENT available?
4.

5. Is STANDBY MAN available and properly trained?

Is FIRE WARDEN on duty (if required)?
6.
Do all persons on the job UNDERSTAND THEIR ROLES
7. and what to do in an emergency?

Have all the persons involved in confined space activities

8. passed SKA confined space entry TRAINING?

For activities conducted in TANKS/VESSELS; were the

tanks/vessels properly CLEANED AND PURGED prior to
9.
start?

For activities conducted in tanks/vessels; is there sufficient

VENTILATION for circulation of fresh air within the
10. vessel?

Is the ACCESS/EGRESS to the Confined Space safe, clear

11. and unobstructed?

Is the AREA PROPERLY BARRICADED off and SIGNS

12.
are in place when confined space activities are performed?
Are all required PPE, as shown on the PTW/RA, being
13. correctly used and in good condition?

Are all TOOLS AND EQUIPMENT being used in GOOD

14. CONDITION and fit for purpose?

Does all lighting used within the confined space have a

rating that does not exceed 12V OR 24V (Class III
15.
electrical equipment) and are EXPLOSION-PROOF?

Any additional comments?

16.

CONFINED SPACE ACTIVITIES CHECKLIST 1

Rev. 2
 I have reminded the workers that when the work is completed the plant, equipment and area must be left clean & tidy & in a
safe condition to hand back to Operations.

Signature/ …………………………………………. Date/

17.
Signature/ …………………………………………. Date/

CONFINED SPACE ACTIVITIES CHECKLIST 2

Rev. 2