# Confined Space Entry Permit Template

> Source: https://netray.co/tools/confined-space-entry-permit-template
> Publisher: Netray (netray.co), AI and integration engineering for ERP and manufacturing systems.
> Section: Free Tools

## Short answer

A fill-in permit for permit-required confined spaces covering hazards, atmospheric testing, isolation, rescue and authorizations.

## Category

ehs-workforce

## Industry

Manufacturing

## Audience

- Safety manager
- Entry supervisor
- Maintenance planner

## Tool

**Kind:** template

**Output:** document

**Fields:**

#### Company / site

**Key:** company

**Type:** text

**Default:** Acme Precision Ltd, Plant 2

#### Space identification

**Key:** space

**Type:** text

**Default:** Coolant sump tank CS-07, Machining Cell 3

#### Purpose of entry

**Key:** purpose

**Type:** textarea

**Default:** Remove sludge and inspect tank wall for corrosion.

#### Permit start date

**Key:** start

**Type:** date

**Default:** 2026-10-20

#### Permit duration

**Key:** duration

**Type:** select

**Options:**

- One shift
- 8 hours
- 12 hours
- 24 hours

**Default:** 8 hours

#### Hazards identified

**Key:** hazards

**Type:** textarea

**Default:** Oxygen deficiency, hydrogen sulfide from coolant degradation, slip hazards, residual fluid.

#### Isolation and lockout measures

**Key:** isolation

**Type:** textarea

**Default:** Pump P-07 locked and tagged. Inlet and outlet valves closed, locked and blanked. LOTO ref LOTO-CS07.

#### Oxygen reading (%)

**Key:** o2

**Type:** text

**Default:** 20.9

#### Flammable gas (% LEL)

**Key:** lel

**Type:** text

**Default:** 0

#### Toxic gas (ppm H2S)

**Key:** h2s

**Type:** text

**Default:** 0

#### Attendant

**Key:** attendant

**Type:** text

**Default:** M. Okafor

#### Authorized entrants

**Key:** entrants

**Type:** text

**Default:** J. Lindqvist, T. Banerjee

#### Rescue arrangement

**Key:** rescue

**Type:** textarea

**Default:** Non-entry retrieval with tripod and harness. On-site rescue team notified. Phone ext. 5555.

**Blocks:**

#### Permit-Required Confined Space Entry Permit

**Body:** Company / site: {{company}}
Space: {{space}}
Start date: {{start}}
Duration: {{duration}}

#### Purpose of entry

**Body:** {{purpose}}

#### Hazards identified

**Body:** {{hazards}}

#### Isolation and lockout

**Body:** {{isolation}}

#### Atmospheric test results (before entry)

**Table:**

**Columns:**

- Test
- Acceptable condition
- Reading
- Time
- Tester initials

**Rows:**

**0:** Oxygen

**1:** Within your site limits (commonly 19.5% to 23.5%)

**2:** {{o2}}

**0:** Flammable gas

**1:** Below your site limit (commonly under 10% LEL)

**2:** {{lel}}

**0:** Toxic gas

**1:** Below the applicable exposure limit

**2:** {{h2s}}

#### Personnel

**Body:** Attendant: {{attendant}}
Authorized entrants: {{entrants}}

#### Rescue and emergency

**Body:** {{rescue}}

#### Entry checklist

**Table:**

**Columns:**

- Item
- Yes
- No
- N/A

**Rows:**

**0:** Space isolated and locked out

**0:** Space purged or ventilated

**0:** Continuous monitoring in place

**0:** Communication method agreed

**0:** Rescue equipment on site and checked

**0:** Entrants trained and equipped (PPE, harness)

**Signatures:**

- Entry supervisor (authorizes entry)
- Attendant
- Authorized entrant(s)
- Permit cancelled by (time and date)

**Notes:** A starting point, not legal advice. Check acceptable atmosphere limits and permit content against 29 CFR 1910.146 (or your local standard) and your own confined space program. Do not enter until all required fields are complete and testing has been done by a trained person with a calibrated instrument.

## Content

**Intro:** Permit-required confined spaces can kill within minutes from oxygen deficiency, toxic gas or engulfment. This template structures the entry permit so nobody enters without testing, isolation and a rescue plan.

**Sections:**

#### How to use the permit

**Body:** The entry supervisor completes the permit before entry, with the attendant and entrants present. Identify the space and purpose, list hazards, describe isolation and lockout, then record atmospheric readings from a calibrated multi-gas meter. Test in order: oxygen first, then flammable gas, then toxic gas. Name the attendant and authorized entrants, write the rescue arrangement, and walk through the checklist. Post the permit at the entry point while work is under way, and cancel it when the job ends or conditions change. Export to PDF and print.

#### What the standard expects

**Body:** In US general industry, 29 CFR 1910.146 requires an entry permit for permit-required confined spaces that includes the space, purpose, date and duration, authorized entrants, attendants, entry supervisor, hazards, measures to isolate and control them, acceptable entry conditions, test results with tester initials, rescue services and communication procedures. The permit must be cancelled after entry operations are complete and retained for at least one year for review. Other countries have equivalents, so check your local rule.

**Bullets:**

- Test and record before entry, and monitor during entry
- Isolate energy sources and lines with lockout and blanking
- Never enter to rescue without a trained rescue plan
- Cancel the permit and keep it for the annual program review

#### Common mistakes

**Body:** Frequent failures include relying on a smell test instead of an instrument, testing only at the opening and not at depth, letting the attendant leave to fetch tools, and writing a rescue plan that depends on the local fire department without confirming response time. Another is reusing last month's permit with the date changed. Tanks that hold coolant, wastewater or solvents can generate hydrogen sulfide or flammable vapor after sitting, so retest even when a space was safe last time.

**Cta:** If you want work orders for tank cleans and inspections to trigger the right permit automatically from your ERP or CMMS, Netray can discuss how.

**Faq:**

#### What is the difference between a confined space and a permit-required confined space?

**Answer:** A confined space is large enough to enter, has limited means of entry or exit and is not designed for continuous occupancy. It becomes permit-required if it has a hazardous atmosphere, engulfment risk, inwardly converging walls or another serious hazard.

#### Who can sign the entry permit?

**Answer:** The entry supervisor, a trained person who has verified that conditions are acceptable and procedures are in place. The same person may also act as attendant or entrant if properly trained, but not at the same time.

#### How often should atmospheric readings be taken?

**Answer:** Test before entry and monitor continuously where possible, or at frequent intervals set by your program. Record results on the permit. Any alarm or change in work conditions means evacuate and retest.

#### Do I need to keep cancelled permits?

**Answer:** In US general industry, cancelled permits must be kept for at least one year to support the annual review of the permit program. Many companies keep them longer.

## Search terms

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