RCR Confined Space Risk Assessment 2

• Document No.

• Confined Space Description

• Business Unit

• Location
  Address

• Permit to Work No.

• CSCC

• Description of Work to be Performed

• Conducted on

  Date

• Prepared by

• Risk Assessment reviewed by Permit Holder

  Sign

• Risk Assessment reviewed by Isolation Sup/Permit Issuer

  Sign

• Personnel

Oxygen concentration must range between 19.5% and 22% : Are there means by which the oxygen level may be depleted?

• Cleaning, purging, ventilation, alternate processes?
  Is BA required if this concentration range cannot be achieved and there is no other practical solution?
  If Atmospheric testing is required, outline the frequency.

• Corrosion processes? i.e. surface corrosion of the walls or equipment inside.

  Yes

  No

  N/A

• Has oxygen been displaced by other gases within the space, or intentionally purged with an inert gas

  Yes

  No

  N/A

• Combustion processes? i.e. use of open flame hot work processes, welding, etc.

  Yes

  No

  N/A

• Absorption by materials within the confined space? (Product in the space that absorbs oxygen)

  Yes

  No

  N/A

• Physical activity? i.e. small confined space, labour intensive work to be performed, many people inside space (depletion through respiration)

  Yes

  No

  N/A

• Any Additional Processes not identified as above

  Yes

  No

  N/A