Confined Space Hazard Assessment Page 3
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3O Space has configuration that will hamper ventilation/purging
O Convoluted space
O Large volume
O Other _________________________
O Additional opening(s) _____________________________________________________
10) Other Considerations: Communications
O Entrants can be visually observed by attendant
O Yes
O No
O Voice only adequate
O Visual hand signal adequate
O Internal telephone available
O Cell Phone required
O Radio required
O Intercom
O Rope signal
11) Adverse Temperatures
O Yes
O No
•
Heat Stress
Hot pipes/lines O Yes
O No ______________________________________________
Steam lines O Yes
O No _________________________________________________
Direct sun exposure O Yes
O No __________ Other O Yes
O No ____________
•
Cold Stress
Coolant lines O Yes
O No ________________________________________________
Ice formation O Yes
O No ________________________________________________
Other O Yes
O No ______________________________________________________
12) Noise/Vibration O Yes
O No
:
Noise
Traffic O Yes
O No
Other: ______________________________________________
Annoyance O Yes
O No
Communications Interference O Yes
O No
Vibration
Discomfort O Yes
O No
Other: __________________________________________
13) Chemical Hazards O Yes
O No
Chemicals present: O Pipes/lines
O Closed tank(s)
O Open tank(s)
O Spilled
Accumulation of O flammable/ O combustible/ O explosive agents O Yes
O No
Chemical Exposure Potential: ____________________ MSDSs available O Yes
O No
14) Radiation Hazards O Yes
O No
Ionizing:
Radioisotopes O Yes
O No _______________________________________________
Sealed Sources O Yes
O No ______________________________________________
Non-Ionizing:
Micro-wave O Yes
O No
Radiofrequency O Yes
O No
Other: _______________
Laser(s) O Yes
O No ____________________________________________________
15) Other Considerations
_________________________________________________________________________
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