Confined space entry permit

Read this before using the form

This template does not authorise anyone to enter a confined space, and it does not replace the training, competence, atmospheric monitoring equipment and rescue capability the law requires. Entrants, standby persons and supervisors must be trained and competent, testing must be done with calibrated equipment by a competent person, and rescue must be arranged before entry, not improvised after an alarm.

Never enter to rescue someone unless you are trained and equipped for confined space rescue. Raise the alarm, call 111, and begin non-entry rescue if the retrieval system allows it. Multiple-fatality confined space incidents almost always begin with an untrained rescuer entering.

Acceptable atmospheric ranges, testing intervals and rescue requirements are set by the regulations in your jurisdiction and by your own procedure. Record the figures you are working to in the fields below and cite their source. Do not rely on remembered numbers.

Permit and space details

Hazard identification

• Oxygen deficiency or enrichment
• Flammable or explosive atmosphere
• Toxic atmosphere, including gases released by disturbing sludge or residue
• Engulfment by liquid or free-flowing solid
• Entrapment by converging walls or a sloping floor
• Stored energy: mechanical, electrical, hydraulic, pneumatic, thermal
• Inflow of liquid, gas or material from connected systems
• Heat stress or cold
• Falls into or within the space, and objects falling onto entrants
• Restricted access or egress affecting escape and rescue
• Noise, poor lighting or poor communications
• Biological hazards

Isolation and preparation

Complete every applicable line before testing. Testing a space that is not isolated tells you only what the atmosphere was at that moment.

Atmospheric testing

Testing is done by a competent person with calibrated equipment, from outside the space, at the top, middle and bottom where the space allows, before entry and at the interval set by your procedure. Record the acceptable range you are working to and its source.

Ventilation and breathing apparatus

• Mechanical ventilation in place, running, and drawing from a clean source
• Ventilation will continue for the whole entry, with a plan for power failure
• Purging completed where required, and the space retested after purging
• Breathing apparatus specified where the atmosphere cannot be made and kept safe
• Air supply duration is sufficient for the task plus escape, with margin
• Users of breathing apparatus are trained, fit tested and medically fit for it

Rescue arrangements, established before entry

Rescue is planned and resourced before anyone enters. If the plan is to call emergency services and wait, confirm they can actually reach and extract from this space, and record their expected response time.

• Rescue plan written for this specific space, not generic
• Non-entry retrieval system in place where the space allows: harness, line and mechanical device
• Rescue team or trained rescuers identified, available and briefed for the duration of entry
• Rescue equipment present, inspected and appropriate to the opening size
• Communications between entrant and standby person tested and continuous
• Method of raising the alarm confirmed, including how to call 111 from this location
• Entrants and standby person briefed on the rescue plan before entry

People

Entry and exit log

The standby person keeps this log and never leaves the entry point while anyone is inside. The count out must match the count in before the permit is closed.

Close-out

• All entrants accounted for and confirmed out of the space, by name
• All tools, equipment and materials removed
• Space secured against unauthorised entry
• Isolations removed and systems restored, with the area owner informed
• Any defect, near miss or unexpected reading recorded and reported