Remote Confined Space Monitoring Log
Complete this form to record all details of remote monitoring for confined space entries. Ensure all sections are filled accurately for compliance and safety.
Confined Space Location/ID
*
Date of Monitoring
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Remote Monitor Name(s)
*
First Name
Last Name
On-Site Personnel Name(s)
*
Type of Work Being Performed
*
Please Select
Inspection
Maintenance
Cleaning
Rescue Drill
Other
Atmospheric Readings (Oxygen, CO, H2S, LEL)
*
Rows
Oxygen (%)
CO (ppm)
H2S (ppm)
LEL (%)
Initial Reading
Periodic Reading 1
Periodic Reading 2
Final Reading
Communication Check with On-Site Personnel
*
Successful
Unsuccessful
Remote Monitoring Equipment Status
*
Camera operational
Audio link operational
Alarm system tested
Other (specify below)
Observations or Incidents Noted
Corrective Actions Taken (if any)
Signature of Remote Monitor (draw your signature)
*
Submit Log
Submit Log
Should be Empty: