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.