Restricted Access Walk - duplicate

• Conducted on

  Date

• Prepared by

• Personnel

RESTRICTED ACCESS

• Area

• Photo of Area

  Media

• Clear signage?

  Yes

  No

  N/A

• Clearly marked on Hazardous Area Map?

  Yes

  No

  N/A

• Access restricted by ;

  Select Guarding / Fencing Padlock / Lock Chained Other

  • Guarding / Fencing
  • Padlock / Lock
  • Chained
  • Other

• Is the means of restriction suitable and sufficient?

  Yes

  No

  N/A
Is the area a confined space

• Contains as per the standard AS2685-2009

  Select Enclosed or partially enclosed Not intended or primarily designed for human habitation Oxygen concentration outside safe range Contains an airborne contaminant that may cause impairment, loss of consciousness or asphyxiation Concentration of flammable airborne contaminant that may cause injury from fire or explosion engulfment in a stored free-flowing solid of rising level of liquid that may cause suffocation or drowning

  • Enclosed or partially enclosed
  • Not intended or primarily designed for human habitation
  • Oxygen concentration outside safe range
  • Contains an airborne contaminant that may cause impairment, loss of consciousness or asphyxiation
  • Concentration of flammable airborne contaminant that may cause injury from fire or explosion
  • engulfment in a stored free-flowing solid of rising level of liquid that may cause suffocation or drowning

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign