Organisation:
GMN Template
ID:
DP-SAF-0004

Project:
Your
First
Project Template
Version:
2




Form
Version:
2
Team:
Your
First
Team Form
created:
Mon,
24
Aug
2020,
9:37
pm

Risk
Assessment
-
Confined
Space
Automated
Form
Number GMN-Your
First
Project-Your
First
Team-DP-SAF-0004-4
Purpose:
This
form
is
to
be
used
as
part
of
the
Working
in
Confined
Spaces
procedure
to
assess
a
Potential
Confined
Space.

Instructions:
Utilise
this
form
to
assess
a
Potential
Confined
Space.
Site
Details
Date Not
set.
Project
Manager:
Supervisor:
Work
Area
Assessor
Details
Assessed
by:
Position:
Confined
Space
Ticket
No.
First
Aid
Certificate
No.
CPR
No.
Confined
Space
Assessment
1.
Is
the
space
enclosed
of
partially
enclosed? Not
selected
Comments
2.
Is
the
space
not
designed
or
intended
to
be Not
selected
occupied
by
a
person?
Comments
3.
Is
the
space
designed
or
intended
to
be
at Not
selected
normal
atmospheric
pressure
while
a
person
is
in
the
space?
Comments
4.
Is
the
space
likely
to
pose
a
risk
to
Health
&
Safety
from
one
or
more
of
the
following:
An
atmosphere
that
does
not
have
a
safe Not
selected
oxygen
level?
Contaminants
that
may
cause
injury
from
fire Not
selected
or
explosion?
Harmful
concentrations
of
any
airborne Not
selected
contaminants?
Have
a
risk
of
engulfment? Not
selected
Comments
If
the
answer
to
Questions
1,
2,
3,
and
at
least
one
of
4
is
Yes,
then
the
space
is
a
Confined
Space.

Generated
with
dashpivot.com Printed
version
is
uncontrolled This
PDF
was
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at

Page
1
of
2 Mon,
24
Aug
2020,
9:40
pm
 Organisation:
GMN Template
ID:
DP-SAF-0004
Project:
Your
First
Project Template
Version:
2




Form
Version:
2
Team:
Your
First
Team Form
created:
Mon,
24
Aug
2020,
9:37
pm

I
have
assessed
the
Potential
Confined
Space
and
have
deemed
that
it
is:
A
Confined
Space Not
selected
Not
a
Confined
Space Not
selected
Signed: Not
signed
yet.
If
you
require
further
clarification
please
contact
the
Content
Expert,
Project
HSEQ
Representative
or
Health
and
Safety
Manager.

Generated
with
dashpivot.com Printed
version
is
uncontrolled This
PDF
was
created
at

Page
2
of
2 Mon,
24
Aug
2020,
9:40
pm