Template

Confined Space Risk Assessment and Entry Permit

by Tiffany Argent, from the Community

Use this comprehensive confined space risk assessment and entry permit to plan, authorize, and document safe entry. Section 1 guides hazard identification, consequence and likelihood ratings, and control measures for slips, traffic, fumes, drowning and more. Section 2 covers isolation of energy sources, purging and ventilation, atmospheric testing for O2, CO, H2S, CO2, LEL and NH3, communication and standby requirements, rescue and retrieval provisions, and PPE. Section 3 records atmospheric test results, entry authorization, personnel sign-on, and withdrawal of the permit to ensure all people and equipment are accounted for.

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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 Risk Assessment and Entry Permit
Confined Space Risk Assessment and Entry Permit
by Christopher Cole, from the Community
Downloads: 80+
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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+
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Template
Confined Space Risk Assessment & Confined Space Permit - Industry Vetted
This checklist was developed by our Industry Expert Partners to facilitate thorough confined space risk assessment and permit issuance. It covers PPE, identification/classification, atmospheric testing, entry procedures, emergency rescue, ventilation, and essential training/documentation. It also includes a dedicated Confined Space Entry Permit section for hazard assessment, personnel authorization, emergency planning, and permit closeout.
by SafetyCulture
Downloads: 1,000+
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Template
Confined Space Permit
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.
by Stephen Dawson, from the Community
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Confined Space Risk Assessment and Entry Permit

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