Templates
Confined space hazard assessment template

Confined space hazard assessment template

Assess potential hazards in confined spaces using this detailed template. It guides you through identifying risks and developing strategies to mitigate them. This template helps enhance safety measures and protect workers in confined environments.

Use this template
or download pdf
Confined space hazard assessment template

Assess potential hazards in confined spaces using this detailed template. It guides you through identifying risks and developing strategies to mitigate them. This template helps enhance safety measures and protect workers in confined environments.

Use this template
or download pdf

About the Confined space hazard assessment template

A confined space hazard assessment template is structured to ensure thorough evaluation of potential dangers in confined spaces. It includes sections for identifying specific hazards, such as toxic gases or limited oxygen levels, and assessing their severity. By using this template, you can systematically address each risk, ensuring that no critical aspect is overlooked.

The template also features fields for documenting control measures and emergency procedures, providing a clear plan for mitigating risks. This structured approach enhances communication among your team, ensuring everyone is aware of the hazards and prepared to manage them effectively. 

Also, the template facilitates compliance with safety regulations, demonstrating your commitment to workplace safety. By implementing this tool, you can optimize your safety management processes and protect your workforce from potential dangers associated with confined spaces, ultimately improving operational efficiency and reducing accidents.

Essential components of a confined space hazard assessment template

A well-structured confined space hazard assessment template is vital for ensuring safety in hazardous environments. Here are the essential components to include:

  • Hazard identification: Begin by cataloging potential dangers like toxic gases, low oxygen levels, or physical barriers. This initial step is crucial for planning effective safety measures and ensuring all risks are acknowledged.
  • Risk analysis: Evaluate the probability and impact of each hazard. This analysis helps you prioritize which risks require immediate attention and resources, ensuring that you address the most critical threats first.
  • Mitigation strategies: Outline the specific controls and safety equipment needed to address identified risks, such as installing ventilation systems or using personal protective gear. Clear documentation of these strategies ensures your team knows exactly how to manage each hazard.
  • Emergency response plans: Detail the procedures for handling emergencies, including evacuation routes and communication methods. Having these plans in place ensures your team can respond swiftly and safely to any incidents. 

Maximizing your use of confined space hazard assessment template

To make the most of a confined space hazard assessment template, focus on accurate documentation. Ensure you capture all relevant details, such as potential hazards and safety measures. This precision helps you identify risks effectively and implement necessary precautions.

Avoid common pitfalls by regularly updating your template to reflect any changes in regulations or safety standards. Staying current ensures your assessments remain relevant and effective.

Utilize the template to streamline your workflow. By standardizing your assessment process, you can ensure consistency and efficiency across different projects. This approach not only saves time but also enhances safety protocols.

Finally, leverage expert advice and best practices to optimize your template use. Incorporate strategies for efficient use, such as prioritizing high-risk areas and involving team members in the assessment process, to ensure comprehensive evaluations.

Categories

  • Health and safety management templates
  • General templates
  • Safety templates
Preview of the template
Audit
Space ID Number
Date of last assessment
Confined Space - must meet all of the criteria below
Is large enough or so configured that an employee can bodily enter and perform work and
Has limited or restricted means for entry and exit and
Is not designed for continuous employee occupancy
Permit Required Confined Space -must be a confined space and meets any of the criteria below
Contains or has the potential to contain a hazardous atmosphere or
Contains a material that has the potential for engulfing an entrant
Has an internal configuration such that an entrant could be trapped or asphyxiated by inwardly converging walls or by a floor that slopes downward and tapers to a smaller cross-section or
Contains any other recognized serious safety or health hazard
Authorized Entry Points
Top
Side
Bottom
Hazards - Explosive Atmosphere
Source type
Quantity and quality (LEL)
Severity
Hazard abatement method
Hazards - Combustible Material
Source type
Quantity and quality
Severity
Hazard abatement method
Hazards - Electrical Circuits
Source type
Quantity and quality
Severity
Hazard abatement method
Hazards - Toxic Gases
Source type
Quantity and quality (PEL)
Severity
Hazard abatement method
Hazards -Toxic Material
Source type
Quantity and quality
Severity
Hazard abatement method
Hazards - Thermal Hazards
Source type (degrees Fahrenheit)
Quantity and quality
Severity
Hazard abatement method
Hazards - Machinery
Source type
Severity
Hazard abatement method
Hazards - Slip and Fall Hazards
Source type
Severity
Hazard abatement method
Hazards - Engulfment Hazards
Source type
Severity
Hazard abatement method
Hazards - Entrapment Hazards
Severity
Source type
Hazard abatement method
Hazards - Pneumatic/Kinetic Energy
Source type
Severity
Hazard abatement method
Personal Protective Equipment Required
Gloves
Coveralls
Hearing protection
Safety glasses
Hard hat
Goggles
Air supplied respirator
SCBA
Line fed
Ventilation Requirements
Space volume in cubic feet
Natural circulation - no atmospheric hazards in place. Additional ventilation may be required for worker comfort, hot work, grinding, or other operations that would produce airborne fumes, mist or dust. Entry Supervisor must assess additional ventilation requirements based on tasks to be performed in the space prior to time of entry.
Mechanical ventilation
Supply
Volume, in cubic feet per minute
Point
Exhaust
Volume, in cubic feet per minute
Point
Local
Volume, in cubic feet per minute
Point
Ventilation Formulas and Requirements
20 Air Changes per Hour. (ACH) required for duration of entry. 20 ACH = space volume x 20
Adequate Blower Capacity (ABC). ABC = space volume x 20 ACH, divided by 60 minutes.
Initial Purge Time. 7.5 x space volume, divided by effective blower capacity.
Required Rescue and Safety Equipment (check if required)
Lifeline
Body harness
Floor level opening barrier
Tripod
Powered communication
Portable lighting
Atmosphere make and model
Electrical equipment
Monitor
Man winch
Fall arrest unit
Emergency retrieval line
Blower
Vent saddle
Vent truck
Ladder
Emergency escape respirators
APR Respirator Cartidges
Acid/gas
OV
DMF
N-95
R-95
P100
Acceptable Entry Conditions
Confined space entry permit closed
Oxygen 19.5-23.5%
Lower explosive level 10%
Toxic fumes/vapors less than PEL
No engulfing materials in space
Continuous air monitoring
Space drained, flushed
Training verified for Supervisor, entrants and attendants
LOTO electrical components in use
LOTO mechanical components in use
LOTO all pipes to and from space
Forced mechanical ventilation established and maintained
No hazardous chemicals or materials
Rescue team available
Pre-entry brief completed
Training verified for rescue team
Maximum internal temperature
Minimal internal temperature
Communication Procedures (between attendant and entrants)
Wireless radio
Line radios
Verbal from access
Line of sight
Rescue Procedures
Self rescue
Non-entry rescue
Rescue team entry
Notes
Notes
Determination
This space has been determined to be a:
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Frequently asked questions

What is a confined space hazard assessment template used for?

You use a confined space hazard assessment template to identify and evaluate potential risks in confined spaces, such as tanks or tunnels. It ensures you take all necessary precautions to protect workers from hazards like toxic gases and limited oxygen, enhancing overall safety.

Who should use a confined space hazard assessment template?

Safety officers, project managers, and team leaders should use this hazard assessment template. It is especially useful for those overseeing operations in hazardous environments, as it ensures thorough documentation, facilitates compliance with safety regulations, and enhances worker protection.

How can a confined space hazard assessment improve safety?

A confined space hazard assessment improves safety by providing a structured approach to identifying hazards and implementing control measures. It ensures consistency in safety evaluations, helps prevent accidents, and facilitates compliance with safety regulations, ultimately protecting workers.

What challenges can a confined space hazard assessment help address?

A confined space hazard assessment helps address challenges such as inconsistent hazard identification, inadequate safety measures, and emergency preparedness gaps. By offering a clear evaluation process, you can identify and resolve issues, ensuring your team is set for confined space work.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.