Confined Space Risk Assessment And Permit
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1
2Confined Space Risk Assessment and Permit
This risk assessment and permit must be used when entry into a confined space is required.
Section 1
Assessor Print Name:
Date of Assessment:
Time of Assessment
Assessor Sign Name:
Location being assessed:
Section 2
The first question you have to ask yourself is do you understand the risks & hazards involved in a confined space entry.
Yes No
Have you received confined space awareness training or confined space entry training.
Yes No
Are you familiar with the space-access-egress-escape routes etc
Yes No
Have you checked the asbestos survey for the area you will be working in
Yes No
If the answer is no to any of the questions above do not proceed and consult your supervisor or line manager.
Section 3
Do any of the risks-hazards identified below exist within the confined space
Risks-Hazard
Yes
No
Risk
Remarks-Control measures
Risk
Before
After
H M
L
H
M L
1
Toxic gases or vapours
2
Explosive or flammable
substances
3
Does the space have poor
ventilation
4
Is there a potential for
Oxygen deficiency or
enrichment
5
Are there any risks from
ingress of gas-vapour-fluids
from other areas? (work
vehicles-generators etc
dumping fumes in to the
space)
6
Will proposed work
affect/change the conditions
within the space and change
its classification
7
Are chemicals stored within
area?
8
Are there problems with
access/egress?
9
Are the entry -exits-and
escape routs more than 200m
apart?
10 Is access within the space
restricted? (pipes-cable tray-
conduits etc)
11 Have fixed ladders been
inspected in accordance with
annual PPM?
12 Is there drainage or sewer
runs within the space. (H²S-
methan-flooding)
13 Excessive heat
14 Other:
If the answer is yes to any of the questions above then the confined space entry permit overleaf must be used/ implemented
GM/H/Permits/2010
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