Confined space entry permit template

Authorize entry into a permit-required confined space: hazards, testing, controls, attendant, rescue and sign-off.

Use it on screen
Confined space entry permitSpace and workPeopleHazards and controlsRescue and communication🕳️
How to use itThe entry supervisor completes and signs the permit before entry, posts it at the entrance and cancels it when the work is done.

When you need the confined space entry permit

Tanks, pits, vaults and silos can contain toxic or oxygen-deficient air or engulfment hazards. Deaths often include would-be rescuers.

OSHA’s permit-required confined space rules set the content of permits, testing and rescue requirements. Use this template with your written program and trained people.

16 items. Fill it in on screen or print a copy.

Space and work

People

Hazards and controls

Rescue and communication

Sign-off

Using the confined space entry permit well

  1. Test the atmosphere before entry and as required during work.
  2. Keep the attendant outside at all times.
  3. Have rescue ready before entry.
  4. Post the permit.
  5. Keep cancelled permits for review.

How a team used the confined space entry permit

Before cleaning a wastewater pit, the supervisor locks out the pumps, ventilates for 20 minutes and records gas readings within acceptable limits. The attendant stays at the hatch with a radio, and the permit is cancelled when the crew exits.

Why a confined space entry permit matters

OSHA’s permit-required confined space rule calls for a written permit listing hazards, test results, people and rescue arrangements before anyone enters. Cancelled permits must be kept for at least a year so the program can be reviewed and problems found during entries can be fixed.

What a completed confined space entry permit looks like

Space Lift station wet well 2
Purpose Remove debris from pump inlet
Time limit 9:00 am to 1:00 pm, August 7
Entrants Luis and Kim
Attendant Ray, at the hatch with a radio
Tests at 9:00 am O2 20.8%, LEL 0%, H2S 0 ppm, CO 2 ppm
Rescue County technical rescue team, confirmed August 6

Sample for Clearwater Utility Services in Ocala, Florida. Readings are written with the time taken so the 11 am retest can be compared line for line, and only two entrants are named, so nobody else who shows up at the hatch is cleared to go in.

Confined space entry permit mistakes

Make it fit your workplace

Utilities and water treatmentBuild a permit for each recurring vault or wet well so hazards and controls are already filled in.
Agriculture and grain handlingAdd engulfment controls for bins and silos, and never allow entry while grain is being moved.
Quick winPut the permit time limit in large print next to the entrance. Crews running long can see at a glance when a new permit or retest is due.

What people ask about the confined space entry permit

What is a permit-required confined space?

A confined space with serious hazards such as hazardous atmosphere or engulfment.

Who signs?

The entry supervisor.

Can the attendant enter for rescue?

Not unless relieved and trained; follow your rescue plan.

How long to keep permits?

Per the standard and your program.

How often should the air be retested during an entry?

Test before entry and then continuously or at the intervals your program sets, and always after a break or any change in conditions. Write each reading with its time on the permit so the attendant can see a trend.

Can one permit cover several days of work in the same space?

A permit cannot last longer than the time needed to finish the job it describes. If work stops overnight, many programs cancel the permit and issue a new one after fresh tests the next morning.

Related resources

More for the same job

Useful next steps

Signed copies in the employee file

Employees can fill in and sign forms like this in the EZTime app, and the signed copy lands in their digital employee file. Book a demo if you want a walkthrough.

Disclaimer: This template is general information to adapt to your own workplace. It is not legal, safety or compliance advice and does not replace inspections, training or requirements set by law, regulators, manufacturers or your insurer. Check the rules that apply to you with a qualified professional.