CONFINED SPACE INSPECTION CHECKLIST

Location: Company: Date/Time:

Please tick () where applicable. 1 2 3 4 5 6 7

1. Safe means of access and egress provided for entry into the confined space
2. Entrance of the confined space is covered or barricaded to prevent unauthorized entry
3. Sufficient and suitable lighting provided for works in the confined space
4. Adequate and effective ventilation provided for personnel working in a confined space
5. Confined space entry permit available?
a. Application by Permit Applicant
b. Evaluation of confined space entry permit by CSSA
c. Issuance of confined space entry permit by Authorizing Manager
6. Posting of confined space entry permit at entrance of the confined space?
7. Periodic atmospheric gas tests performed by CSSA at regular intervals?
8. Continuous gas monitoring by personnel with a suitable gas detector while working inside the
confined space?
9. Any incompatible works?
10. Warning signs available at strategic locations of the confined space?
11. Display of ID tags of personnel working inside the confined space at the entrance?
12. Mandatory approved training for personnel working in the confined space?
13. Confined space attendant available
Others (please specify):

Inspected by(Subcontractor supervisor in charge):

(name) (sign) (date/time)

Verified by(Hexacon Trade in charge):

(name) (sign) (date/time)