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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 2 times.

Permit and Planning

NaN of 11

Ensuring a thorough permit is created and all planning is complete before entry.

Permit Issue Date

Permit Issue Time

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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

NaN of 11

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

NaN of 11

Verifying the atmosphere within the confined space is safe for entry.

Initial Atmosphere Testing Time

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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

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Carbon Monoxide (CO) Level (ppm)

Ventilation and Air Supply

NaN of 11

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

NaN of 11

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

NaN of 11

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

NaN of 11

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)

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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

NaN of 11

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

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Personal Protective Equipment (PPE)

NaN of 11

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

NaN of 11

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

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Post-Entry Procedures

NaN of 11

Steps to be taken after exit from the confined space, including permit closure and equipment inspection.

Entry Exit Time

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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?

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