Template

Permit to Work for Dangerous Enclosed Space

by Tyronne De Ponte, from the Community

10+

Comprehensive maritime permit to work template for dangerous enclosed space entry. Includes scope of work, roles and responsibilities, toolbox talk notes, ventilation and access checks, gas monitoring and acceptable limits, PPE requirements, communications, rescue readiness, and sign off. Provides sections for atmosphere testing, including oxygen at least 20 percent, combustibles below 1 percent LFL, hydrogen sulfide within safe limits, and carbon monoxide below 2 percent. Captures initials of entrants, responsible person handover, authorization, validity period, and closure. Designed for vessels with references to Bridge and engine control room notifications.

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Confirm accountability and compliance with a digital log

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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 Job Hazard Analysis JHA
Use this Confined Space Job Hazard Analysis checklist to plan safe entry. Identify hazards from housekeeping and walking surfaces, and verify atmosphere with a calibrated four gas meter. Confirm oxygen 19.5 to 23.5 percent, LEL under 10 percent, carbon monoxide under 35 ppm, and hydrogen sulfide under 10 ppm. Set ventilation, communication between attendant and entrants, and a clear rescue plan. Address material handling limits and mechanical aids, hot work controls, required PPE, and electrical safety with GFCI and tool inspections.
by Alex White, from the Community
Downloads: 40+
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Template
Confined Space Entry Checklist
Use this Confined Space Entry Checklist to assess the space, confirm permit requirements, and implement controls before work begins. Document site details, JSEA or SWMS, rescue plan, isolations, ventilation, and required equipment such as barricades, tripod, gas monitors, radios, and lighting. Record atmospheric tests for oxygen 19.5% to 23.5%, combustibles below 5% LEL, hydrogen sulfide below 25 ppm, and carbon monoxide below 400 ppm. Authorize entry, log entrant sign in and out, and complete closeout to verify all personnel and equipment are accounted for and the space is reinstated safely.
by Greg Smith, from the Community
Downloads: 20+
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Template
Confined Space Work Permit
Use this confined space work permit template to plan and control safe entry. Capture site details, list trained entrants, verify gas meter calibration, and record atmospheric test results for oxygen, lower explosive limit, hydrogen sulfide, and carbon monoxide or carbon dioxide. Identify hazards such as combustible gases, electrical, mechanical, chemical, temperature, engulfment, entrapment, and flooding, then document controls. Specify PPE, communications, ventilation, and lighting. Assign a hole watch, hold a pre entry briefing, authorize entry with signatures, and set permit expiry. This template is a starting point only and does not replace professional advice.
by Regan McCarthy, from the Community
Downloads: 0
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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
Downloads: 10+
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Permit to Work for Dangerous Enclosed Space

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