Confined Space Reclassification Form
Document your confined space review and determine if the space can be reclassified. Please complete all relevant fields.
Space Name or ID
*
Location of Confined Space
*
Date of Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewer Name
*
Hazards Present (Select all that apply)
Oxygen Deficiency
Toxic Atmosphere
Engulfment
Mechanical Hazards
Electrical Hazards
Other
Controls in Place (Select all that apply)
Ventilation
Lockout/Tagout
Continuous Monitoring
Physical Barriers
Procedural Controls
Other
Has the space been made free of all hazards?
*
Yes
No
Reclassification Decision
*
Space reclassified as non-permit required
Space remains permit required
Reviewer Comments
Reviewer Signature
Submit
Submit
Should be Empty: