Confined Space Entry Risk Assessment

/ Form 000.653.F0197
Confined Space Entry Risk Assessment
Space: / Location (specify): / Work to be Done:
Nature of the space:
Type of space - vat, tank, pit, etc.; where it’s located; adjacent processes that may affect risk; size and internal structure of the space - room to move/equipment that may hinder progress; material of construction of the space; soundness and security of the space; illumination and visibility.
The range of methods by which the work can be done and selected method of working:
Consider - can work be done without entry; work methods to reduce risk; and work methods that reduce time in the space.
Any work to be performed outside the space that may create a risk to any employee in the space:
Consider possible sources of atmospheric contamination of the space - breathing air, fire, and explosion.
The means of entry to and exit from the confined space:
Consider - number, size, and location of entry and exit points; entry and exit routes; equipment used to gain entry and exit; and adequacy of entry and exits, especially for rapid entry and exit and rescue.
Type of emergency procedures required:
Consider - adequacy and availability of first aid, hospital, ambulance; number of workers in the space; nature of hazards and severity of risk; adequacy and availability of rescue equipment required and its location; training of rescuers; safeguards for rescuers; fire fighting; and rehearsal of procedures.
Other factors:
Consider - fitness and training of personnel; and physiological and psychological factors.
Selected Method of Working / Any Change That May Occur in the Level of Oxygen or Contaminant / Hazards / Control Measures
(also refer to entry permit)

Note: This form is referenced in Practice000.653.3322.