Template

Confined Space Permit

by Stephen Dawson, from the Community

Use this confined space permit to plan and authorize entry into tanks, pits, vessels, and other confined spaces. The form captures permit identifiers, work scope, location, start and finish times, isolation and lockout verification, atmospheric testing requirements and results, ventilation, PPE, communication, standby and rescue arrangements, and continuous monitoring. It includes approvals, issue, acceptance, clearance, and closure sections, plus a gas test record for oxygen, flammable gases, CO, H2S, and dust or fibers. Suitable for construction, facilities, utilities, manufacturing, and mining operations.

With SafetyCulture you can

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

With SafetyCulture you can

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

About author

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 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
Downloads: 10+
Get
Template
Energis Confined Space Entry Permit
Use this Confined Space Entry Permit to plan and control safe entry into tanks, pits, vaults, and other confined spaces. The checklist guides teams to identify hazards (oxygen deficiency, toxic or combustible gases, temperature, mechanical and electrical risks), define minimum PPE, confirm ventilation and air monitoring, and set entry, communication, rescue, and lockout/tagout requirements. Record atmospheric readings before and during entry, document rescue equipment and contacts, and capture approvals and signatures from entrants, attendants, and the entry supervisor. Includes sections for permit duration, access points, and permit closeout.
by Sean Wall, from the Community
Downloads: 10+
Get
Template
PC HS 25 Confined Space Entry Permit
This PC HS 25 Confined Space Entry Permit template helps teams plan and authorize safe entry into confined spaces. Record project details, location, work scope, permit number, and date. Verify gas testing for oxygen, H2S, explosivity, CO, and other gases with equipment type and calibration dates. Confirm the safe system of work, removal of noxious substances, and full isolation from energy sources. Checklist items cover access control, communications, standby person, first aid, signage and barriers, PPE, intrinsically safe tools, adequate lighting and ventilation, tripod and retrieval gear, and escape breathing apparatus. Document continuous gas monitoring, pre-entry briefing, worker medical fitness and training, and emergency rescue arrangements. Supervisor authorizes before entry and cancels the permit once work is complete and the area is left safe. Permit validity is limited to one day.
by Kevin Baker, from the Community
Downloads: 0
Get
Template
Pre-Task Confined Space Checklist and Permit
Use this pre-task confined space checklist and permit to conduct a thorough pre-entry review for permit-required confined spaces. Confirm job scope, hazards and risk assessment, isolation and lockout, ventilation and lighting, signage and access, communications methods, and atmospheric monitoring with calibration and logging. Select required equipment and PPE, and complete emergency and rescue planning details. Includes team briefing plus entrant and supervisor sign-off to verify training, conditions, and authorization before work begins.
by WPN Facilities, from the Community
Downloads: 10+
Get

Confined Space Permit

About author

You might also like

Confined Space Permit to Work

Energis Confined Space Entry Permit

PC HS 25 Confined Space Entry Permit

Pre-Task Confined Space Checklist and Permit

You might also like

Confined Space Permit to Work

Energis Confined Space Entry Permit

PC HS 25 Confined Space Entry Permit

Pre-Task Confined Space Checklist and Permit