Site and construction · SI-03

Confined Space Entry Permit

A free printable confined space permit — isolation, testing, ventilation, communication, attendant and the rescue arrangements, all recorded before entry.

Download Free · no sign-up

2 pages. Choose your paper size — both versions are laid out identically, so neither one gets shrunk to fit.

Print it and write on it

A4 58 kB US Letter 58 kB

Fill it in type and save

A4 102 kB US Letter 102 kB

The fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.

What this sheet is for

Force the rescue arrangements to be written down and in place before anybody enters, alongside the isolation and testing for this specific space.

Who it is for

Water and drainage contractors, farms with slurry stores and silos, breweries, tank and vessel work, and premises with pits, chambers or voids.

How to use it

Establish first whether the entry can be avoided altogether.
Record the actual test readings and the times they were taken.
Say how often testing will be repeated, and do it.
Post an attendant outside for the whole entry, named on the permit.
Have rescue arrangements that have been rehearsed — not a phone number.

What is on the sheet

2 pages, in this order:

Page 1

Printed under the title: A permit for entry into a confined space, with the rescue arrangements written down before anyone goes in.

No limits are printed. They are yours to establish. No atmospheric limits, gas readings, test intervals or entry durations are printed here, and none are implied — they must come from a competent assessment of this particular space. Entry without workable rescue arrangements has killed a great many people, including the people who went in after them. Who may authorise and carry out this work, what training and certification they need, what must be recorded and how long it must be kept differ by country and by workplace. This sheet names no scheme, sets no criteria and satisfies no regulation on its own — check what applies where you are.

Write-on lines: Permit number · Site · Date · Valid from · Valid to · Exact location of the work · Company or team · The work, described precisely

Hazards identified for this job — including the space itself, the contents and the work being done

Ruled lines

Controls required before work starts — written by the person authorising, for this job

Ruled lines

Page 2

Also confirmed

Space isolated, drained, purged and proved
Atmosphere tested — record the readings and times above
Testing to be repeated as specified above
Ventilation in place and running
Communication method agreed and tested
Attendant posted outside for the whole entry
Rescue arrangements in place and rehearsed
Rescue equipment present and checked

People covered by this permit

Table, 4 rows: Name · Company · Role · Signed on accepting the permit · Time in · Time out

Issue

Write-on lines: Issued by (print) · Position · Signature · Time

Handback and cancellation

Write-on lines: Work complete or suspended · Area left safe and clear · Equipment removed · Handed back by · Accepted by · Date · Time

Ruled lines: Anything the next entry team should know

Questions

Why are no gas limits or entry times printed?

Because they must come from a competent assessment of the particular space and the work being done, and a printed figure is exactly what somebody would rely on instead. This is a recording form, not a procedure.

Is this enough to work safely in a confined space?

No. Confined space work needs trained people, tested equipment and workable rescue arrangements, and in many places it is specifically regulated. Would-be rescuers make up a large share of the people killed in these spaces. If you are not sure you are competent to plan this, do not enter.