Big River Steel ~ Confined Space Determination

• Audit Title

• Department :

• Area / Building :

• Physical characteristics and configuration of space :

• Prepared by :

• Conducted on :

  Date
• Location :
  Address

• Person completing evaluation

1. Confined Space Determination

• Size : Is the opening for the space large enough or configured in such a manner to permit bodily entry?

  Yes

  No

  N/A

• Access / Egress : Are there limited or restricted means of access or egress?

  Yes

  No

  N/A

• Occupancy: Is the space designed for continuous human occupancy.

  Yes

  No

  N/A

• Is this space a confined space?

  Yes

  No

  N/A

2. Permit / Non-Permit Determination - Assess if the confined space has one or more of the following characteristics to be considered a permit-required confined space.

• A. Contains or potential to contain a hazardous atmosphere?<br>(If YES, provide description below)

  Yes

  No

  N/A

• Potential Oxygen Hazard ( 19.5, > 23.5)%

• Please describe:

• Explosive Atmosphere

• Please describe:

• Toxic / Hazardous Substances

• Please describe

• Other Hazards:

• Please describe:

• B. Contains a material that has the potential for engulfing an entrant. If yes, provide description below.

  Yes

  No

  N/A

• C. Has an internal configuration such that an entrant could become trapped or asphyxiated. If yes, please describe below.

  Yes

  No

  N/A

• D. Contains any other recognized serious safety or health hazard. If yes, please provide description below.

  Yes

  No

  N/A

• Electrical:

• Please describe:

• Mechanical Motion:

• Please describe:

• Fall Hazard:

• Please describe:

• Steam:

• Please describe:

• Other:

• Please describe:

3. Determination of permit-required confined space

• 3. Is this space a permit-required confined space?

  Yes

  No

  N/A

4. Potential concerns not affecting permit status ( examples, asbestos piping, low lighting, etc.)

• Concerns not affecting permit status:

  Yes

  No

  N/A

Based upon the answers to the questions above, define the type of confined space.

• Nonregulated space

  Yes

  No

  N/A

• Nonpermit Confined Space

  Yes

  No

  N/A

• Alternate Entry Procedure Allowed

  Yes

  No

  N/A

• Permit Required Confined Space

  Yes

  No

  N/A

• Additional notes or observations:

• Additional drawings, if necessary

  Drawing

• Add signature

  Sign