Confined Space Identification and Risk Assessment

• Client / Site

• Location
  Address

• Space #

• Head of Department

• Conducted on

  Date

• Prepared by

• Description of space

CRITERIA

• Confined Space Criterion - For the space to be confined, all points (1.1 to 1.4) must be answered with a yes.

• Is the space intended to be, or is likely to be entered by any persons for any reason (e.g. maintenance, production or inspection)?

  No

  Yes

  N/A

• Does the space have limited or restricted means of entry and exit for personnel?

  No

  Yes

  N/A

• Is the space intended to be at normal atmosphere pressure while any person is in the space?

  No

  Yes

  N/A

• Is the space likely to contain or once contained: <br><br>an atmosphere that a harmful level of any contaminant (e/g fumes, vapor, steam, gas or explosive gas? or <br>an atmosphere that does not have a safe oxygen level (e.g too low or too high)? or <br>any stored substance that could cause engulfment (e.g sand, garnet, grit, blast, grain)?

  No

  Yes

  N/A

CLASSIFICATION

• Classify the space

  CONFINED SPACE

  NOT A CONFINED SPACE

RISK ASSESSMENT

• Entry: Is the space likely to or intended to be entered? (eg inspection of parts, maintenance requirements)

  No

  Yes

  N/A

• Atmosphere: Is there a risk of the atmospheric pressure within the space changing to an unsafe level?

  No

  Yes

  N/A

• Prior to entering the space, is there any risk of the atmosphere being unsafe? (eg fuel vapors, lack of oxygen due to decomposing material or explosive vapors)

  No

  Yes

  N/A

• Once inside the space, is there a risk of any harmful contaminant or process entering the space or being created from inside? (eg fumes, carbon monoxide or gas leak, pipes, ducts, sewers)

  No

  Yes

  N/A

• Are any of the processes occurring inside or adjacent to the space likely to cause any oxygen deficiency?

  No

  Yes

  N/A

• Can any other substances be introduced into the space whilst being occupied? (eg water, oil or fuel)

  No

  Yes

  N/A

• Lighting: Could there be insufficient lighting?

  No

  Yes

  N/A

• Are there any possible hazards associated with the lighting in the space? (eg an explosive atmosphere)

  No

  Yes

  N/A

• Electricity: Are any electrical hazards present?

  No

  Yes

  N/A

• Communication: Is continual communication between the personnel inside the space and the standby difficult?

  No

  Yes

  N/A

• Entanglement: Is there a risk of entanglement from moving parts and or plant within the space?

  No

  Yes

  N/A

• Personal Protective Equipment: Does the design, purpose or layout of the space require PPE irrespective of the work carried out inside the space?

  No

  Yes

  N/A

EMERGENCY ASSESSMENT

• Describe the features of the confined space e.g. type of access, number access point, conditions inside the space

• Description of emergency process to be taken in an emergency e.g. will require emergency services – fire brigade, CFA, boom lift, mechanical ventilation etc

• Description emergency equipment required for the confined space entry e.g. lifting equipment, torch, leather gloves

ASSESSMENT TEAM

• Authorized person responsible for reviewing and implementing the risk assessment including the identified controls (Full Name and Signature)

• List the names of the consultants

Consultant

• Full Name and Signature

• Full Name and Signature of Inspector