Confined Spaces Risk Assessment Form

Part 1 General description of work

Location of work

General description

Who will be carrying out the work

Dimensions of the confined space

Part 2 Hazards

Question Answer Is there a risk to those who

will work in the area?
What is/was stored in the
confined space?
Are there any chemical residues?
Are there materials or substances
likely to enter from adjacent
processes?
What are the dimensions of the
confined space?
Are harmful or explosive
substances likely to be present?
Are flammable or toxic gases or
vapours likely to be present?
Can power supplies be isolated?

Is there a danger of explosion?

Will sources of ignition be

introduced?
Can work take without the need
for PPE/RPE?
Will any combustible materials be
present?
Will there be extreme
temperatures or humidity?
Part 3 Emergency arrangements

Are there arrangements for safe

access and exit?
Is suitable rescue equipment
provided?
Can the alarm be raised in the
event of an emergency?
Are fire extinguishers provided
where there is a risk of fire?
Can nearby plant and equipment
be isolated?
Are there suitable first aid
arrangements?
Part 4 Method statement

This method statement takes account of the risks identified during the risk assessment.
Supervision

Competence of operatives

Means of communication

Testing/monitoring the
atmosphere
Gas purging

Ventilation

Removal of residues

Isolation from gases, liquids, etc.

Mechanical/electrical isolation

Work equipment

PPE (including RPE)

Access and egress

Fire prevention

Lighting

Static electricity

Emergencies and rescue

Work time restrictions

Prohibitions the following Smoking

activities are not permitted The use of internal combustion engines
The use of portable gas cylinders
Welding

Other relevant information

Signature of Assessor

Date of Assessment

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