Annex I | Confined space checklist - rev00

Location: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Plant/Equipment: _ _ _ _ _ _ _ _ _ _ _
PTW No. _ _ _ _ _ _ _ _ _ _ Confined Space Certificate No: _ _ _ _ _ _ _ _ _ _

1. Safety Meeting YES NO

• Have the following key personnel who are involved in confined space entry or work been
appointed?
• Do the planned works inside confined space are clearly described, including the work
schedule?
• Do the Contents of the confined space are clearly identified?
• Have Preparation works been completed, including removal and clean up of chemicals from
the confined space?
• Have Hazard identification and risk assessment been reviewed and approved?
• Have all aspects of safety measures been discussed and identified during the pre-job safety
meeting ?.

• Are all Name of entrants, attendants, supervisors and rescue team have been determined?
• Have all employees been informed of the existence of these confined spaces and warned of
the possible hazards?

2. Risk Assessment

• Have all confined space entry or work been assessed on the necessity of conducting such work
at the workplace?
• Has a risk assessment been conducted to identify, evaluate and control all risks arising from
entry or work in confined spaces?
• Are the risk control measures selected based on the following hierarchy for management of
confined space hazards?
• Are confined space hazards re-evaluated when new operations or work procedures are
introduced or when current operations or work procedures are altered?
• Are all provision and safe use of safety equipment and personal protective equipment in
place?

3. Permit

• Has the Confined Space Entry Certificate been issued.?

• Has the proper PTW for the job been issued ?
• Are other required certificates issued and attached to the main PTW form?
• Is a copy of the confined space entry certificate displayed prominently at the entrance to the
confined space?

• Are the identification badges of entrants displayed at the entrance to the confined space?

4. Testing
• Are All instruments used in atmospheric testing are calibrated?
• Is the person in charge for atmospheric testing competent and qualified?
• Is the atmosphere in confined space has been tested before start?
• Is the Oxygen content at least 20.8%, but not more than 21%.?

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Annex I | Confined space checklist - rev00

• Are the following toxic, flammable or vapor gases present: Hydrogen sulphide, carbon
monoxide, methane, carbon dioxide, others (……………………..)?
• Is the Checking and evaluation of the gas measurement results have been done?
• Have you checked NORMs level in the confined space?
• Are the test results within the acceptable criteria?
• Are the results recorded in the entry permit?

5. General Safety Provisions

• Are safe means of access and egress provided for movement of entrants to and within the
confined space?

• Are all system depressurised and rendered safe prior to opening?

• Are all confined space openings barricaded or guarded properly after opening?

• Are all openings effectively covered to prevent objects from falling through?

• Is there sufficient and suitable lighting provided for entry into and work in confined space?

• Are all electrical installation and equipment in use well constructed and properly maintained?

• Are all moving parts inside the confined space secured?

• Are warning signs posted at the entrances of confined space?

6. Monitoring

• Did you provide mean to sure the atmospheric in confined space will be monitored while work
is going on.?

• Did you Prepare a monitoring time table and items for the atmospheric in confined space.?
• Are all means to prevent unauthorized entry into the confined space including the display of
warning signs in place?

7. Ventilation

• Are you sure the confined space has been ventilated before entry.?
• Will the Ventilation be continued during entry.?
• Are you sure that the air intake (supply) for the ventilation system is free of combustible
dust/vapor and toxic gas/vapor?

8. Isolation

• Has The confined space been isolated from other systems.?

• Has Electrical equipment been safely locked out.?

• Have the required Block valves been closed and have all required blind plates been inserted.?
• Has the Mechanical equipment been blocked, chocked and disengaged?
• Has The confined space been separated from pressurized pipe lines and equipments, by
disconnecting or closing the valves?.

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Annex I | Confined space checklist - rev00

• Have all Tags been put at the related block valves and blind plates to the confined space.?

9. Equipment, Clothing, Tools & Personal Protective Equipment

• Has Special equipment been provided and authorized?

• Have all Special clothing required for the work inside confined space been provided (disposal
coveralls, chemical suit, boots, safety shoes, goggles, masks, etc..)?
• Have all Special tools required for the job been provided and inspected safe for use prior to
start the job?
• Has Lighting requirement been fulfilled prior to start the job ?

10. Training

• Have The entrants, attendants, supervisors and rescue teams have followed confined space
entry training.?

11. Standby/Rescue Team

• Is There a standby person or rescue member on the outside of confined space in constant
visual and auditory communication with the entrants inside the confined space.?
• Are rescue team members present on site prior to start the job .?
• Are the duties and responsibilities of all employees (including key personnel) clearly
stipulated?
• Are rescue equipments available on site?
• Have sufficient supplies of rescue equipment been provided/made readily available?
• Are the rescue equipment properly maintained?

HSE Supervisor: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature : _ _ _ _ _ _ _ _ _ _ _ _ _ _

Contract Holder Representative: _ _ _ _ _ _ _ _ _ _ _ _Signature : _ _ _ _ _ _ _ _ _ _ _ _ _ _

pro hse 024 eni Iraq r00 – Annex I

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