Confined Space Risk Assessment Form

Use the Confined Space Risk Assessment Form to ensure safety measures by inspecting equipment, conducting training, etc. for safety in confined spaces.

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Health & Safety
Confined Space Risk Assessment Form

General

Permit Required Confined Spaces

Training

Atmosphere

Equipment

Permit

General

Permit Required Confined Spaces

Training

Atmosphere

Equipment

Permit

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Confined Space Risk Assessment Form

Use the Confined Space Risk Assessment Form to ensure safety measures by inspecting equipment, conducting training, etc. for safety in confined spaces.

1. Is there an inventory of all possible confined spaces, whether these are permit-required or non-permit-required?

2. Is each space classified as permit required or non-permit required?

3. Is there documentation of initial atmospheric testing for each non-permit-required confined space?

4. Has each non-permit required space been reviewed at least annually to ensure conditions have not changed?

5. Have the hazards of each space, permit, and non-permit required, been documented?

1. Has a Permit-Required Confined Space program been written, implemented, and made available to employees?

2. Are danger signs posted to inform employees about the existence, location, and dangers of confined spaces?

3. Is a permitting system in place sufficient to protect employees from the hazards within each permit-required confined space?

4. Is the program reviewed annually and updated if necessary?

1. Has each employee been trained and demonstrated proficiency in the understanding, knowledge, and skills necessary for the safe performance of duties relating to the confined space?

2. Are employees trained before the first assignment, before there is a change in assigned duties, and whenever there is a change in permit space operations that present a hazard about which the employee has not previously been trained?

3. Has the employee training been certified by recording the names of the employees, the signature of the trainer, and the date of training?

4. Have the entrants been trained in the hazards of the entry, the signs of exposure, how to properly use the equipment, and communicate with the attendant?

5. Have the attendants been trained in the hazards of the entry, to recognize the behavioral effects of hazard exposure in authorized entrants, and to call for rescue services if necessary?

6. Have the supervisors been trained in the hazards of the entry and understand his/her role in assuring all conditions of the entry permit have been met?

7. Has the employer evaluated the rescuers' or emergency service’s ability to respond in a timely manner?

1. Has the permit space been tested to determine if acceptable entry conditions exist prior to entry?

2. Has the entry supervisor reviewed and signed the permit before entry began?

3. Was atmospheric hazard testing done in the proper order? (oxygen, then combustible gases and vapors, and then toxic gases and vapors)?

4. Is ventilating equipment available to obtain and maintain acceptable entry conditions?

5. Has the permit space been flushed, ventilated, purged, and rendered inert to eliminate or control atmospheric hazards prior to entry?

6. Is the permit space tested or monitored as necessary to determine if acceptable entry conditions are being maintained while employees are working in the space?

7. Have the employees been trained to properly care for the air monitoring equipment?

8. Is all equipment calibrated before each entry and at least annually by the manufacturer?

9. Are confined spaces thoroughly emptied of any corrosive, hazardous, or decaying substance that may produce a hazardous atmosphere?

1. Is necessary personal protective equipment available?

2. Has necessary lighting equipment been provided?

3. Has all equipment been locked out and tagged?

4. Is all portable electrical equipment used inside the confined space either grounded and insulated or equipped with ground fault protection?

1. Are all the employees involved in the entry listed on the permit?

2. Has the entry supervisor signed off on the permit indicating that entry conditions are acceptable?

3. Are completed entry permits posted near the confined space entrance for all involved to observe?

4. Are the permits saved for one year for review?

1. Is there an inventory of all possible confined spaces, whether these are permit-required or non-permit-required?

2. Is each space classified as permit required or non-permit required?

3. Is there documentation of initial atmospheric testing for each non-permit-required confined space?

4. Has each non-permit required space been reviewed at least annually to ensure conditions have not changed?

5. Have the hazards of each space, permit, and non-permit required, been documented?

1. Has a Permit-Required Confined Space program been written, implemented, and made available to employees?

2. Are danger signs posted to inform employees about the existence, location, and dangers of confined spaces?

3. Is a permitting system in place sufficient to protect employees from the hazards within each permit-required confined space?

4. Is the program reviewed annually and updated if necessary?

1. Has each employee been trained and demonstrated proficiency in the understanding, knowledge, and skills necessary for the safe performance of duties relating to the confined space?

2. Are employees trained before the first assignment, before there is a change in assigned duties, and whenever there is a change in permit space operations that present a hazard about which the employee has not previously been trained?

3. Has the employee training been certified by recording the names of the employees, the signature of the trainer, and the date of training?

4. Have the entrants been trained in the hazards of the entry, the signs of exposure, how to properly use the equipment, and communicate with the attendant?

5. Have the attendants been trained in the hazards of the entry, to recognize the behavioral effects of hazard exposure in authorized entrants, and to call for rescue services if necessary?

6. Have the supervisors been trained in the hazards of the entry and understand his/her role in assuring all conditions of the entry permit have been met?

7. Has the employer evaluated the rescuers' or emergency service’s ability to respond in a timely manner?

1. Has the permit space been tested to determine if acceptable entry conditions exist prior to entry?

2. Has the entry supervisor reviewed and signed the permit before entry began?

3. Was atmospheric hazard testing done in the proper order? (oxygen, then combustible gases and vapors, and then toxic gases and vapors)?

4. Is ventilating equipment available to obtain and maintain acceptable entry conditions?

5. Has the permit space been flushed, ventilated, purged, and rendered inert to eliminate or control atmospheric hazards prior to entry?

6. Is the permit space tested or monitored as necessary to determine if acceptable entry conditions are being maintained while employees are working in the space?

7. Have the employees been trained to properly care for the air monitoring equipment?

8. Is all equipment calibrated before each entry and at least annually by the manufacturer?

9. Are confined spaces thoroughly emptied of any corrosive, hazardous, or decaying substance that may produce a hazardous atmosphere?

1. Is necessary personal protective equipment available?

2. Has necessary lighting equipment been provided?

3. Has all equipment been locked out and tagged?

4. Is all portable electrical equipment used inside the confined space either grounded and insulated or equipped with ground fault protection?

1. Are all the employees involved in the entry listed on the permit?

2. Has the entry supervisor signed off on the permit indicating that entry conditions are acceptable?

3. Are completed entry permits posted near the confined space entrance for all involved to observe?

4. Are the permits saved for one year for review?