Confined Space Entry Procedures Checklist
Ensure worker safety with our comprehensive Agriculture Confined Space Entry Procedures checklist! Protect your team from silos, bins, tanks & more. Download now for legal compliance & peace of mind. #AgricultureSafety #ConfinedSpace #Checklist #FarmSafety
This Template was installed 5 times.
Permit and Planning
Ensuring a thorough permit is created and all planning is complete before entry.
Permit Issue Date
Permit Issue Time
Description of Confined Space
Purpose of Entry
Detailed Entry Procedures
Authorized Entry Personnel (Names/IDs)
Attendant/Monitor Name/ID
Maximum Entry Time (Hours)
Potential Hazards Identified
Permit Authorizer Signature
Hazard Identification and Evaluation
Identifying and assessing all potential hazards within the confined space.
Describe the Confined Space (e.g., grain bin, fertilizer tank, silo)
Potential Atmospheric Hazards Present?
Describe any physical hazards present (e.g., entanglement, suffocation, falling)
Potential Energy Sources?
Describe any other hazards identified (e.g., biological, ergonomic)
Estimated Depth/Height of Confined Space (feet/meters)
Hazard Severity Ranking (Low, Medium, High)
Confined Space Atmosphere Testing
Verifying the atmosphere within the confined space is safe for entry.
Initial Atmosphere Testing Time
Oxygen Level (%)
Flammable Gas Level (ppm)
Hydrogen Sulfide (H2S) Level (ppm)
Atmosphere Test Results - Safe?
Notes on Atmosphere Testing (if not safe)
Re-testing Interval
Carbon Monoxide (CO) Level (ppm)
Ventilation and Air Supply
Establishing and maintaining adequate ventilation and/or supplying breathable air.
Ventilation Method Selected
Airflow Rate (CFM) - Forced Ventilation
Air Supply Source
Oxygen Level (Percentage)
Carbon Monoxide (CO) Level (ppm)
Ventilation Procedure Notes
Air Supply Line Integrity Verified?
Ventilation System Last Inspection Date
Isolation and Lockout/Tagout
Ensuring the confined space is isolated from all potential energy sources and hazards.
Identify Energy Sources
Describe 'Other' Energy Sources (if selected)
Lockout/Tagout Procedures Completed?
Pressure Reading (if applicable)
Lockout Device Placement
Describe 'Other' Lockout Device Placement (if selected)
Verify Lockout/Tagout Effectiveness
Describe 'Other' Verification Methods (if selected)
Entry Personnel & Roles
Defining roles and responsibilities for all personnel involved in the confined space entry.
Entry Supervisor Designation
Entry Supervisor Name
Entry Team Leader Name
Entry Team Member(s) - Indicate all who are entering
Attendant/Monitor Designated?
Attendant/Monitor Name (if applicable)
Brief Description of Roles & Responsibilities for Entry Team
Attendant Responsibilities
Specific tasks and duties of the attendant/monitor outside the confined space.
Describe the Attendant's Primary Responsibility
Attendant Trained in Confined Space Rescue?
Distance of Attendant from Confined Space Entry (feet)
Scheduled Rotation Time (if applicable)
Describe the Communication Method Used (e.g., radio, verbal)
Attendant has clear view of entrants?
Describe any unusual noises or conditions observed outside the confined space.
Communication
Establishing and maintaining reliable communication between entrants and the attendant.
Primary Communication Method
Detailed Communication Plan
Radio Channel/Frequency (if applicable)
Signal Person Position
Emergency Communication Protocol
Backup Communication Method
Last Communication Check Time
Personal Protective Equipment (PPE)
Ensuring appropriate PPE is selected and worn by all personnel.
Required PPE - Head Protection
Required PPE - Eye/Face Protection
Required PPE - Respiratory Protection
Required PPE - Hand Protection
Required PPE - Body Protection
Fit Testing Status (Respiratory)
Retrieval and Emergency Procedures
Planning for and practicing retrieval procedures and emergency response.
Describe the retrieval plan, including equipment and techniques.
Maximum Retrieval Time (minutes)
Retrieval Equipment Available (Check all that apply)
Emergency Contact Information (Name, Phone)
Emergency Scenarios Considered (Check all that apply)
Describe emergency escape routes and procedures.
Date of last emergency drill
Estimated time to summon emergency services
Post-Entry Procedures
Steps to be taken after exit from the confined space, including permit closure and equipment inspection.
Entry Exit Time
Observations During Entry (Deviations, Concerns, etc.)
Permit Status
Oxygen Meter Reading (Post-Entry)
Equipment Condition After Use
Notes Regarding Equipment Condition
Permit Expiration Date Verified
Permit Revalidation Needed?
Agriculture Management Solution Screen Recording
Grow your farm smarter with ChecklistGuro! This screen recording shows how to manage crops, track resources, and improve efficiency on your farm. See how it works! #agriculture #farmmanagement #checklistguro #bpm #businessprocessmanagement #farming #agtech
Related Checklist Templates
Soil Erosion Control Measures Inspection
Implement Attachment Secureness
Planting Depth Accuracy
GPS/Precision Farming Equipment Calibration
Soil Moisture Monitoring (Location-Specific)
Weed Infestation Mapping
First Aid Kit Inventory and Restock
Drainage System Efficiency Check
Soil pH Level Verification
Post-Harvest Storage Conditions Monitoring
We can do it Together
Need help with Checklists?
Have a question? We're here to help. Please submit your inquiry, and we'll respond promptly.