Confined Space Entry Permit

A ready-to-use confined space entry permit modeled on OSHA 1910.146 requirements. Print it, fill it out at the entry site, and keep the signed copy for your records.

CONFINED SPACE ENTRY PERMIT

OSHA 29 CFR 1910.146 compliant · Complete all sections before entry

Permit Date

8/26/2026

1. General Information

Site / Facility

Space to be entered

Reason for entry

Entry Supervisor

Permit expiration

Date / time

2. Personnel

Entrant(s)

List full names

Attendant(s)

List full names

Communication method

Radio, voice, tug line

Rescue service contacted

Name & phone

Backup entrants (if applicable)

3. Atmospheric Testing (record results before entry & after any break)

Oxygen (%)

Safe: 19.5–23.5%

LEL (%)

Safe: below 10%

H₂S (ppm)

Safe: per PEL

CO (ppm)

Safe: per PEL

Other

Tester initials / time

4. Hazard Controls (check each item verified)

Oxygen content 19.5–23.5%LEL below 10%H2S within safe limitsCO within safe limitsContinuous atmospheric monitoringForced-air ventilation in placeLockout/Tagout applied & verifiedPPE selected for the hazardCommunications method establishedRescue plan reviewed with the teamNon-entry rescue equipment readyBarriers / signs posted as needed

5. Equipment In Use

Ventilation (CFM / location)

Retrieval system setup

Respirator type & cartridge

Required only if IDLH

Tripod / winch / harness

Lighting (Class & Div rated)

Other equipment

6. Communications & Rescue Plan

Describe rescue procedures, designated rescue personnel, equipment location, and hospital / emergency contact if needed:

7. Authorization & Cancellation

Entry Supervisor Signature (authorizes entry)

Date / time

Attendant Signature (accepts attend duties)

Date / time

Entrant Signature(s)

Cancellation (Entry Supervisor)

Date / time entry completed & space secured

This permit is invalid after the expiration time or if conditions change. Cancel and reissue a new permit for any new entry. Retain completed permits per your facility's record retention policy.