Confined Space Entry Safety Audit Form
General Information
Date:
Time:
Auditor Name:
Location:
Permit Number:
Job Description:
Pre-Entry Checklist
Item
Yes
No
N/A
Comments
Permit has been issued and authorized?
Hazard assessment completed?
Atmospheric testing documented?
Isolation completed (lockout, blanking, etc.)?
Rescue equipment available?
Entry Team
Name
Role
Trained (Yes/No)
Yes
No
Yes
No
Yes
No
PPE & Equipment
PPE Provided:
Additional Equipment:
Comments/Observations
Auditor Signature
Signature: