Confined Space Entry Checklist

Citation
242 FW 11
Exhibit
2
Supersedes
242 FW 11, FWM 273, 09/30/96
Date
FWM
N/A

     HAZARDOUS ATMOSPHERES VENTILATION

               INFORMATION/TRAINING

____Flammability

____Attendant

____Oxygen content

____Entrants

____Combustible dust, visual

____Supervisor

____Toxic gas measurement

____Contractors

____Exhaust

____Nearby workers

____Air Supply

____Rescue team

____Inert atmosphere

____Signs, posting

                Physical Hazards

                           Personal Protective Equipment

____Electrical

____Respirator

____Life line, lanyard

____Mechanical

____Glasses/goggles

____Retrieval line, harness, wristlet

____Tripping hazards

____Hard hat

____Communication system(s)

____Caustics or acids

____Gloves

____Lighting

____Temperature extremes

____Clothing

____Attendant

____High pressure

____Hearing protection

____Buddy system

____Animals, insects, plants

____Face shield

____Secure all materials

____ Limited/obstructed entry

         points

____Other (specify)

Isolation

___Lockout/tagout

___Blinding/blanking*

___Disconnect

___Barricades

 

___Rescue service contacted

 
      

Completed By: ________________________________      Date/Time Completed: _______________________

Location Completed for: ________________________________________________________________________

[*] Blind blanking means inserting a solid barrier across the open end of a pipe leading into or out of a confined space, and securing the barrier so that nothing leaks into the confined space.