• Confined Space ID # (If already classified as a confined space):

  • Location of Space(s):

  • Add location
  • Process/Item Name:

  • Take a picture of the space:

  • Squadron:

  • Office Symbol

  • Commander/FM's Name and Grade:

  • DSN:

  • 1. Is the space large enough for an employee's whole body to enter?

  • 2. Are there limited/restricted openings making entry/egress difficult?

  • 3. Is the space designed for continuous human occupancy?

  • 4. Identify all that apply to the space:

  • List recognized/known hazards:

  • 5. Is it possible to eliminate all the hazards without anyone entering the space?

  • How/Why?

  • 6. How frequently will the space be entered?

  • How Often?

  • 7. Location(s) and description of the space to be entered (If not specific enough above):

  • 8. Purpose of entry into the space

  • 9. Tasks or operations to be performed in the space: (attach separate list if more space is needed)

  • Commander/FM Justification (Optional):

  • Commander/FM Signature

  • Date of Assessment

  • Tenant/OSM Signature

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