Confined Space System Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 Risk Management

• 1.1 AMS/TRA Number & References:

  Yes

  No

  N/A

• 1.2 Have potential hazards associated with Confined Space (CS) been identified and documented in the Workplace Risk Assessment(WRA)?

  Yes

  No

  N/A

• 1.3 Has the confined space identification form been completed for the space to be entered?

  Yes

  No

  N/A

• 1.4 Has a TRA been completed for the Confined Space Entry Activity?

  Yes

  No

  N/A

• 1.5 Can the workers identify the applicable hazards associated with the Confined Space Entry activity?

  Yes

  No

  N/A

• 1.6 Are the controls identified on the TRA in place prior to the entry into the confined space? (e.g. Trained workers, ventilation, atmospheric monitoring, permit control, sentry allocation and confined space rescue plan)

  Yes

  No

  N/A

• 1.7 Where applicable are any client specified confined space entry requirements being implemented?

  Yes

  No

  N/A

2.0 Training

• 2.1 Do those who supervise and carry out Confined Space work hold the appropriate training for CS activities?

  Yes

  No

  N/A

3.0 Confined Space Permit

• 3.1 Has the Confined Space entry Permit been completed for the task?

  Yes

  No

  N/A

• 3.2 Permit Number:

  Yes

  No

  N/A

• 3.3 Issue Date/ Time:

  Yes

  No

  N/A

• 3.4 Expiry Date/Time:

  Yes

  No

  N/A

• 3.5 Do the names of workers undertaking the Confined Space Entry Activity appear on the CS permit?

  Yes

  No

  N/A

• 3.6 Has their manager/supervisor communicated the requirements of the WAH permit to them and do they understand it's requirements?

  Yes

  No

  N/A

4.0 Confined Space Equipment

• 4.1 Is the Confined Space Entry equipment recorded in a central register, inspected and maintained in accordance with JHG CS procedures?

  Yes

  No

  N/A

• 4.2 Is the Confined Space Entry rescue equipment in date tested and ready to use?

  Yes

  No

  N/A

• 4.3 Is the Confined Space monitoring equipment in date, tested and calibrated?

  Yes

  No

  N/A

• 4.4 Are the workers involved able to demonstrate how to effectively test the confined space environment with air monitoring equipment?

  Yes

  No

  N/A

5.0 Emergency Response

• 5.1 Is this emergency equipment referenced on the Confined Space Entry Rescue Plan attached to the permit?

  Yes

  No

  N/A

• 5.2 Have Confined Space emergency rescue responsibilities been assigned?

  Yes

  No

  N/A

• 5.3 Have the emergency personnel been trained?

  Yes

  No

  N/A

• 5.4 Have any emergency response exercises been carried out to maintain rescue effectiveness?

  Yes

  No

  N/A

6.0 Corrective Action/s

• Are there any corrective actions required to be raised as a result of this system assessment?

  Yes

  No

  N/A

7.0 Sign Off

• Person Conducting the System Assessement

  Sign