Confined Space Risk Assessment JHA

Confined Space Entry Checklist
Date
Task
Location
Classification of Permanent (Risk Potential Confined Permit to work YES/ NO

confined space: assessment must be Area (A risk assessment (CS) required:
reviewed to ensure it is must be carried out)
valid)
Other permits to work required: (i.e. Isolation etc) * YES/ NO
Checklist completed Name: Date:

by *
Verified by * Name: Date:
Person in charge * Name: Date:

*Must be Authorised and competent with regard to confined space
Personnel involved in Confined Space Task
Name: Qualification in Signature (at Confined Space):

date:
Appointed
Person
Person in Charge
Entry Team:
* Where other permits are required, these must be actioned before works / entry can commence.
Initial (Peak) atmosphere readings (taken at near bottom, mid and near top of access / confined space)
H₂S Top O₂ Top Flammable Top CO Top- Other Top

gas (Specify)
Mid Mid (normally Mid Mid. Mid.
methane)
Bot. Bot. Bot. Bot. Bot.
PPM % Vol % LEL PPM PPM
Limits H₂S - <5 ppm; O₂ 19-33 ppm; Methane <10% LEL; CO - 30 ppm
NB:- Where atmospheric testing indicates that the levels cannot be brought into the ‘Safe’ range, and that
these levels cannot be readily maintained, then entry to the space must not be allowed. Any works required in
this area including inspection must be carried out by a company specialising hazardous atmosphere working.
Support equipment required? Yes No Support equipment required? Yes No

Personal gas monitors Ropes
Air Movers Manhole lifting key
Tripod / winch (& harness) Barriers
Torches Ladders
Escape set PPE
Where equipment is identified as required, it must be tested and within date (where applicable) and visually
checked to ensure it is ‘fit for purpose’
Indicate Means of communication:

Entrant to entrant:
Entrant to Person in Charge
Person in Charge Emergency Services:
Weather report: (required where the weather can have an adverse effect on the workers and the confined
space)
Confined Spaces - RISK ASSESSMENT
Title of risk assessment Department Date
Description of activities:
Persons at risk Staff Trainees *Young people Contractors Customers Visitors
Detailed Description of the confined space, (inc dimensions, access snd plant within the space)
Hazards Existing control measures Additional control measures required By whom/when

Include brief explanation as to how they may cause Consider; safety devices, cut-out switches, safety signs, Required to prevent/reduce likelihood of hazard occurring. Person responsible and
harm. SOPs, training, PPE. etc completion date.
Is there is any risk of atmospheric

pressure change within confined space to
unsafe level
Evaluation of risk Severity: Likelihood: Risk factor:
Prior to entering space, is there any risk of

atmosphere being unsafe?
Eg: fuel vapours, lack of oxygen etc...

Hazards Existing control measures Additional control measures required By whom/when
Include brief explanation as to how they may cause Consider; safety devices, cut-out switches, safety signs, Required to prevent/reduce likelihood of hazard occurring. Person responsible and
harm. SOPs, training, PPE. etc completion date.
Once inside the space, is there a risk of
any harmful contaminant or process
entering the space or being created from
inside.
Eg: fumes,gasleaks,ducts,sewer,water,oil,
fuel, etc,,

Is there sufficient lighting
Is there any electrical hazard present
Is there thermal hazard of working under hot

environment.

Is continuous communication between person
inside and standy difficult?
Summary of assessment: The area / activity has been assessed against existing control measures in place. The assessment has identified (number) issues and made (number)
recommendations for additional control measures.
Signature of assessor: ______________________________________________ Name: _______________________________________ Date: ____________________

ECM
Matrix for risk evaluation

Severity of injury
Likelihood Superficial Minor Serious Major Extreme
Unlikely Very low Very low Low Low Moderate
Possible Very low Low Low Moderate High
Likely Low Low Moderate High Very high
Very likely Low Moderate High Very high Very high
Extremely likely Moderate High Very high Very high Very high
Rating for severity of injury
Superficial Injury; none, delay only
Property damage; minimal
Minor Injury; bruising, minor cuts, light abrasions.
Health effects; mild irritation of skin or eyes, headaches, ill-health leading to
temporary discomfort.
Property damage; minor
Lost time; < 3 days
Serious Injury; loss of consciousness, lacerations, concussion, serious sprains, minor
fractures, deafness, asthma, burns or injury resulting in absence from work.
Health effects; acute health effects, e.g. harmful if inhaled/contact with skin/ or
swallowed, dermatitis, ill-health leading to minor but permanent disability.
Property damage; serious but confined to a work-room or area. Oxidising,
flammable and highly flammable substances.
Lost time; > 4 days – 3 months
Major Injury & illness; affecting one person, permanent disability or other reportable
injury/disease for example amputations/major fractures. Severely life shortening
diseases, acute fatal diseases.
Health effects; affecting one person, toxic by inhalation/contact with skin or
swallowed. Damage to eyes, respiratory system, skin sensitization, effects on
fertility, prolonged exposure risks, limited evidence of carcinogenic effects.
Property damage; major. Extremely flammable and explosive substances.
Lost time; > 3 months
Extreme Injury; fatal incidents affecting more than one person
Health effects; affecting more than one person or chronic medical disability due to,
for example exposure to a probable carcinogen, may cause sensitization by
inhalation.
Property damage; the loss of one or more buildings.
Rating for likelihood
Unlikely Appropriate control measures in place with effective management of risk
Possible Appropriate control measures in place with partial management of risk
Likely Inadequate / inappropriate control measures in place with partial management of
risk
Very likely Inadequate / inappropriate control measures with no management of risk
Extremely Absence of control measures with no management of risk
likely
Prioritisation of risk factors
Very low Acceptable risk; no action required
Low Tolerable risk; reduced as low as reasonably practical, further action may not be
required
Moderate Plan required to reduce the risk as far as is reasonably practical
High Urgent action required to allow activity to continue. Plan required for sustainable
risk control.
Very high Risk intolerable; activity must cease until the risk has been reduced

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Confined Space Entry Checklist

Classification of Permanent (Risk Potential Confined Permit to work YES/ NO

Checklist completed Name: Date:

Person in charge * Name: Date:

Personnel involved in Confined Space Task

Name: Qualification in Signature (at Confined Space):

H₂S Top O₂ Top Flammable Top CO Top- Other Top

PPM % Vol % LEL PPM PPM

Support equipment required? Yes No Support equipment required? Yes No

Indicate Means of communication:

Title of risk assessment Department Date

Persons at risk Staff Trainees *Young people Contractors Customers Visitors

Hazards Existing control measures Additional control measures required By whom/when

Is there is any risk of atmospheric

Evaluation of risk Severity: Likelihood: Risk factor:

Prior to entering space, is there any risk of

Evaluation of risk Severity: Likelihood: Risk factor:

Evaluation of risk Severity: Likelihood: Risk factor:

Evaluation of risk Severity: Likelihood: Risk factor:

Is there any electrical hazard present

Evaluation of risk Severity: Likelihood: Risk factor:

Is there thermal hazard of working under hot

Evaluation of risk Severity: Likelihood: Risk factor:

Evaluation of risk Severity: Likelihood: Risk factor:

Signature of assessor: ______________________________________________ Name: _______________________________________ Date: ____________________

Matrix for risk evaluation

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Signature of assessor: __________________________ Name: _ Date: __