Pre-Entry Check Lists for Confined Spaces

OSHA estimates 2.1 million Americans, annually, will enter a confined space at work and approximately 100 of them won’t come home. Of these 100 deaths over 61% are caused by simple mistakes during construction or routine maintenance. These kind of workplace accidents can be avoided by more complete training and more thorough entry preparation. The first step in preparing to enter a confined space is the pre-entry checklist used to identify any potential hazards and determine if a permit is required. Please remember that during the pre-entry check communication is a worker’s best chance for survival and at least two employees are required to be onsite during work in confined spaces.

While completing the pre-entry check, a permit is required if any of the following are occur:  a hazardous atmosphere is detected, the space contains a material that has engulfing potential, it’s an extremely tight entrance, or any other serious safety hazard. A permit for certified confined spaces can be found in Appendix D of subpart J in OSHA’s 1910 Safety Regulations.

Confined Space Pre-Entry Checklist

I. General Information
Space Type/Manhole Identification: _________________________________
Date/Time: _______________
Shop: _____________________
Employee Names: _____________________________________________

II. Non-Permit Required Confined Space Pre-Entry Checklist

Potential Hazard	Yes, this is a potential hazard identified in the initial confined space classification	Is this potential hazard secured, eliminated, or if applicable is monitoring being performed?
Atmospheric hazard
Mechanical hazard
Electrical hazard
Thermal hazard
Noise hazard
Vibration hazard
Fire or explosion hazard
Engulfment/Entrapment hazard
Materials harmful to skin

List Other Potential Hazards	Yes, this is a potential hazard identified in the initial confined space classification	Is this potential hazard secured, eliminated, or if applicable is monitoring being performed?

If any of the initial identified potential hazards are active hazards as indicated by a “No” answer above, then this space shall be reclassified as a Permit Required Confined Space. A non-permit required confined space might also require reclassification based on the type of work to be performed in the space, for example welding.

Comments: __________________________________________________________________________
______________________________________________________________________________

If an atmospheric hazard is indicated as a potential hazard in Section II above, a direct reading gas monitor shall be used to check the atmosphere and the results shall be listed below. If conditions are not acceptable the space shall be reclassified as a Permit Required Confined Space.

III. Atmospheric Hazard Data
Please collect and document pre-entry readings in the specified order when a potential atmospheric hazard exists:

• At surface after cover is removed
• 3 feet from the surface
• 6 feet from the bottom
• 3 feet from the bottom

					Acceptable Conditions
O2	%O2	%O2	%O2	% O2	>19.5% and < 23.5% O2
Explosive	%LFL	%LFL	%LFL	%LFL	<10% LFL
Toxic	ppm CO	ppm CO	ppm CO	ppm CO	< 25 ppm CO
	ppm H2S	ppm H2S	ppm H2S	ppm H2S	<10 ppm H2S

Time Sampled: ____________________________
Tester Signature and Date: ___________________________________________
Instrument Name/Serial Number: ______________________________________
Instrument Calibration Date: ____________________________