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Confined Space Questionnaire


Name: _________________________                               Company: ____________________

  1. Must a permit be completed before entry into any confined space?
  1. Yes.
  2. No.

  1. If hot work or other work requiring a permit is to be done in the confined space, do you need to complete a permit for that work?
  1. Yes.
  2. No.

  1. A JRA and STA must be completed and reviewed by all the personnel involved with the confined space entry.
  1. True.
  2. False.

  1. A test of the air inside the space must be completed before any personnel enter the space.
  1. True.
  2. False.

  1. How would entry and exit be controlled for the confined space? How would anyone know who is inside at any time?
____________________________________

  1. May the standby person leave the area whilst personnel are inside the confined space?
  1. Yes.
  2. No.

  1. Does the standby person need to be trained for this role?
  1. Yes.
  2. No.

  1. How would we warn other personnel that the area is a confined space and that no-one else is permitted to enter if we have no one in the area?
____________________________________

  1. Is it necessary to have a rescue plan ready in case of an emergency in the confined space?
  1. Yes.
  2. No.


Signature: _________________________

Date: _______________                                                             

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