Get the free Confined Space Assessment Form - unh

This form is used to assess and determine if a space is classified as a confined space and if it requires a permit for entry due to potential hazards.

How to fill out confined space assessment form

How to fill out Confined Space Assessment Form

1. Gather necessary information about the confined space, including its location and purpose.
2. Identify potential hazards associated with the space, such as chemical, physical, and biological risks.
3. Determine necessary controls and safety measures to mitigate identified risks.
4. Fill out the assessment form with the gathered information in the designated sections.
5. Ensure all team members involved in the work are aware of the assessment and its findings.
6. Review and update the form as needed when conditions change or new hazards are identified.

Who needs Confined Space Assessment Form?

1. Workers who will be entering the confined space.
2. Safety officers responsible for overseeing safety protocols.
3. Supervisors and managers in charge of confined space work.
4. Emergency responders who may need to access the space in case of incidents.

People Also Ask about

What does a confined space entry include?

Entry means the action by which a person passes through an opening into a permit-required confined space. Entry includes ensuing work activities in that space and is considered to have occurred as soon as any part of the entrant's body breaks the plane of an opening into the space.

What is a confined space evaluation form?

Confined Space Assessment Form. Instructions: All confined spaces must be assessed using this form. The purpose of this form is to identify the hazards and characteristics of a space to determine if it is a non-permit required space or a permit-required confined space.

Does OSHA require a written confined space program?

If the employer decides that its employees will enter permit spaces, the employer shall develop and implement a written permit space program that complies with this section. The written program shall be available for inspection by employees and their authorized representatives.

What are the 5 criteria for confined space?

OSHA uses the term "permit-required confined space" (permit space) to describe a confined space that has one or more of the following characteristics: contains or has the potential to contain a hazardous atmosphere; contains material that has the potential to engulf an entrant; has walls that converge inward or floors

What are the OSHA requirements for a confined space?

How Does OSHA Define a Confined Space? The space must be “large enough and so configured that an employee can bodily enter and performed assigned work” AND. The space must “have limited or restricted means for entry or exit” AND. The space must not be “designed for continuous employee occupancy”.

What is an example of a confined space risk assessment?

An example is a partially enclosed tank with occasional exposure to fumes. High risk: These are spaces with significant risks because they contain hazardous substances or there is a high potential for entrapment or engulfment. Examples include chemical storage tanks, sewage systems, and grain silos.

What are 10 examples of confined spaces?

Examples of confined spaces Manholes. Sewers. Storage tanks and vats. Excavations. Trenches. Pits. Tunnels. Lift and access shafts.

What is a confined space entry checklist?

This document is a checklist for confined space entry that contains 26 requirements to ensure worker safety. It requires isolating energy sources, testing the atmosphere for hazards, using ventilation and appropriate PPE, notifying rescue services, and having proper communication and rescue equipment available.

For pdfFiller’s FAQs

What is Confined Space Assessment Form?

The Confined Space Assessment Form is a document used to evaluate and identify hazards in confined spaces before work begins, ensuring that safety measures are in place.

Who is required to file Confined Space Assessment Form?

The Confined Space Assessment Form must be filed by employers, safety professionals, or designated personnel responsible for overseeing work in confined spaces.

How to fill out Confined Space Assessment Form?

To fill out the Confined Space Assessment Form, identify the confined space, assess potential hazards, list necessary safety precautions, and provide details about the workers and the work to be performed.

What is the purpose of Confined Space Assessment Form?

The purpose of the Confined Space Assessment Form is to document the assessment process, ensure compliance with safety regulations, and protect workers from the risks associated with confined spaces.

What information must be reported on Confined Space Assessment Form?

The information reported on the Confined Space Assessment Form includes the location and description of the confined space, identified hazards, required safety measures, personnel involved, and the date of assessment.