High Risk Activity Scoring

Rev 0
Confined Space Entry
Assessor Details:
Name:
Company:
Department:
Date of Assessment:
Time of Assessment:
Area of Assessment:
Supervisor of the group
being assessed:
Company of group being
assessed:
Scoring: No evidence of implementation: 0; Little evidence of implementation: 1; Fairly well
implemented: 2; Fully implemented: 3
Element: Score: Comments:
1. Recognition of a confined space, whether
it is: an excavation, inside a vessel, a
manhole, pipes, tanks etc. Evaluate the
hazards that, upon entry (or even sticking
one’s head inside), there will be a
potential for; a hazardous atmosphere
(e.g. flammable or explosive gases),
entrapment, the introduction of other
mediums, oxygen enrichment or
deficiency, or inert gases incapable of
2. supporting human
Permit control occupancy.
obligatory.
3. Gas tests & sequence of retest as required.
4. Isolations as required executed by;
spading, lock out tag out etc.
5. Trained hole watch.

6. Check in / Check out board to ensure all

persons inside confined space are
accounted for.

7. Standby rescue team if required, with:

SCBA & communication link to hole watch
& emergency services.
8. Intrinsically safe tools.
9. Reduced voltage lighting inside confined
space. (Less than 50 volts).
10. Forced ventilation where feasible.
11. Tripod rescue equipment set up as
required.
12. Temperature control or limited shifts in
 High Risk Activity Scoring
Rev 0
Confined Space Entry
hot conditions.
13. Specific PPE requirements & compliance as
laid down in permit.
14. Equipment that can become charged with
static electricity to be earthed.
15. Cables against sharp edges of confined
space to be bound together & to be
protected from damage.
Total Score: /45

Additional Comments: