Template

Confined Space Evaluation Form

by Jeffrey Viehmann, from the Community

This confined space evaluation form helps teams determine if a space is permit-required and safe to enter. Record location and description, assess access and occupancy, identify hazards such as hazardous atmospheres, engulfment risks, inwardly converging walls, mechanical and energized equipment, chemical and gas lines, temperature extremes, and hot work. Verify permits, isolation and lockout/tagout, ventilation, atmospheric testing, PPE, communication, attendants, and rescue plans before entry. Capture notes, photos, and sign-offs to document compliance and improve safety.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Confined Space Evaluation Survey
Use this confined space evaluation survey to determine if a space meets OSHA 1910.146 criteria and whether it is permit-required. Document atmospheric, engulfment, configuration, and other hazards; specify PPE, monitoring, ventilation, isolation, and rescue procedures; and capture photos and notes for compliance.
by Jack Deyne, from the Community
Downloads: 10+
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Template
Confined Space Assessment
This confined space assessment checklist helps teams classify spaces, identify hazards, and verify permit-required entry controls. Review atmospheric, engulfment, and configuration hazards; specify monitoring, ventilation, PPE, retrieval, and communication needs; confirm rescue arrangements; and document SDS review, isolation, testing, and hot work permits. Capture comments and signatures to ensure compliance and safer confined space operations.
by Ralpat98 User, from the Community
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Template
Confined Space Assessment Form
This Confined Space Assessment Form helps determine whether a space qualifies as permit-required by evaluating size, access, occupancy, and potential hazards. It guides users through atmospheric, engulfment, configuration, and other risks, and captures required PPE, monitoring, ventilation, isolation, and communication needs. It also documents rescue team readiness, retrieval systems, MSDS reviews, hot work permits, and special requirements for non-permit spaces, with space for photos, comments, and signatures.
by David Johnson, from the Community
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Template
Confined Space Permit to Work
This Confined Space Permit to Work template supports safe entry and maintenance in tanks, boilers, and process equipment. It guides teams through hazard identification, isolation and lockout/tagout, ventilation and temperature checks, gas testing and continuous monitoring, PPE requirements and intrinsically safe tools, standby and rescue arrangements, communication checks, and hot work controls. It includes sections for atmospheric tests, rescue plans, authorisation and acceptance, permit expiry, and hand-back and cancellation, helping organisations standardise confined space procedures and compliance.
by Richard Smith, from the Community
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Confined Space Evaluation Form

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