Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Background, scope and details of space
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1. Provide detail about the space being assessed including the type and nature of the space, Register number if applicable and types of hazards expected within the space
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2. Provide photographs of the space being assessed.
NSW - WHS Regulation 2011
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Is the space enclosed or partially enclosed?
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Is the space designed or intended primarily to NOT be occupied by a person?
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Is the space at, or designed / intended to be at normal atmospheric pressure while any person is in the space?
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Does the space meet all of the above criteria? If so, proceed with the question below; if not, this space is not a confined space.
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Is the space likely to be a risk to health and Safety from:<br>a) at atmosphere that does not have a safe oxygen level, or<br>b) contaminants, including airborne gases, vapours and dusts, that may cause injury from fire or explosion, or<br>c) harmful concentrations of any airborne contaminants, or<br>d) engulfment
VIC - OHS Regulations 2007
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Is the space in any; Vat, tank, pit, pipe, duct, flue, oven, chimney, silo, reaction vessel, container, receptacle, underground sewer or well, or any shaft, trench or tunnel or other similar enclosed or partially enclosed structure?
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Is the space likely to be, entered by any person?
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does the space have a limited or restricted means for entry or exit that makes it physically difficult for a person to enter or exit the space?
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Is the space, or is it intended to be, at normal atmospheric pressure while any person is in the space?
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Does the space meet all of the above criteria? If so, proceed with the question below; if not, this space is not a confined space.
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Does the space contain, or is it intended to contain, or is likely to contain;<br>a) an atmosphere that has a harmful level of any contaminant; or<br>b) an atmosphere that does not have a safe oxygen level; or<br>c) any stored substance, except liquids, that could cause engulfment?
Assessment Summary
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Using the information gathered in the assessment, make a determination on the status of the space as either a confined space or not; be specific to identify which exclusions apply.,
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Please identify any specific risk controls which must be applied to this space.
