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Confined space entry permit template
A confined space entry permit filled in on a phone at the hatch. It names the space, the purpose and the time the permit is valid, the entry supervisor, the attendants and each entrant with their time in and out. It records the hazards, the isolation and controls, and the acceptable entry conditions you set, then logs every atmospheric reading (oxygen, % LEL, H2S, CO) with the time and the tester, and flags any reading outside your limits. Rescue, communication, equipment, other permits, the supervisor's signature and the cancellation finish it. Plan the entry first with the confined space risk assessment and the confined space rescue plan.
For entry supervisors, attendants, utility and pump station crews, and contractors working in wet wells, vaults, manholes, tanks and pits.
One form for the US and Great Britain: pick the rules on page 1 and it shows the OSHA construction (1926 subpart AA) or general industry (1910.146) notes, or the Confined Spaces Regulations 1997 and HSE L101 notes.
- Every item OSHA lists for an entry permit, in the order of 29 CFR 1926.1206
- Atmospheric readings with time, place and tester, each checked against the limits you enter
- Entrants with times in and out, a count of anyone still shown inside
- Isolation and controls, rescue and how to summon it, and the supervisor's signature
- Suspension or cancellation, problems found, and follow-up actions
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What must a confined space entry permit include?
A permit is useful when someone at the hatch can read it and know exactly who is inside, what the space can do to them, what has been isolated, what the air was when it was last tested and by whom, and who comes if it goes wrong. Readings logged with the time and the tester, against limits written on the permit, turn a signature into a record of the entry.
Last updated . Facts checked by the SiteSurvey team on 27 October 2026 against OSHA 29 CFR 1926.1206, entry permit (construction), eCFR, OSHA 29 CFR 1926.1205, permitting process (construction), eCFR, OSHA 29 CFR 1926.1204, permit-required confined space program (construction), eCFR, OSHA 29 CFR 1926.1202, definitions (construction confined spaces), eCFR, OSHA 29 CFR 1910.146, permit-required confined spaces (general industry), eCFR, Confined Spaces Regulations 1997, regulation 4, work in confined spaces, Confined Spaces Regulations 1997, regulation 5, emergency arrangements and HSE L101, Safe work in confined spaces: Approved Code of Practice and guidance (third edition).
How to fill in a confined space entry permit
Fill it in at the entry point on the day, after the space has been evaluated and the rescue arrangements are in place.
Name the space and the job
Pick the rules that apply, then enter the space, its way in and out, the purpose of the entry and the times the permit is valid. Photograph the entry point.
List the people
Enter the entry supervisor and the attendants, then each entrant, or the roster or tag board you use to track who is inside.
Record hazards and controls
Tick the hazards of the space and confirm each isolation and control is in place: lockout, blanking, draining, ventilation, barriers, lighting and the ladder. List the equipment and any other permits, such as hot work.
Set the limits and test
Enter the acceptable limits from your program or safe system of work. Test oxygen first, then flammables, then toxics, and log each reading with the time and the tester. The form flags any reading outside your limits.
Confirm rescue and sign
Enter the rescue service and how to summon it, and how entrants and the attendant keep in contact. The entry supervisor signs before anyone goes in.
Close the permit
When the work is done, or a reading goes out of limits, record the time, that everyone is out, and any problems. List follow-up actions and sign off.
What makes a confined space entry permit useful
Each atmospheric reading, with time, place, tester and the check against your limits
Lift station wet well, US construction rules. Limits from the district program: oxygen 19.5 to 23.5 percent, flammables 10 percent LEL, H2S 10 ppm, CO 25 ppm. 07:50 before ventilation: H2S 8 ppm. 08:15 after ventilation: H2S 1 ppm, entry authorized at 08:18. 10:10 worn monitor alarmed at 14 ppm H2S by the inlet: entrants out by 10:13, permit suspended, a leaking inlet plug re-inflated, 30 minutes of ventilation, retested at 10:55 and the space reassessed before re-entry.
Fictional example. Record the actual evidence and approved arrangements for your job.
A common recording mistake
Signing the permit before the post-ventilation test, or writing "gas OK" with no figures, no time and no tester, so nobody can tell later what the air was when people went in.
What happens next
Cancel the permit when the work is done, note any problem on it and keep it for the program review. Fix the follow-up actions before the next entry.
Try the confined space entry permit form live
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Want to see one filled in? See a completed confined space entry permit report (PDF), made by SiteSurvey from a fictional site visit.
Every question in the confined space entry permit template
A confined space entry permit filled in at the entry point: the space, purpose, date and duration, entry supervisor, attendants and entrants with times in and out, hazards, isolation and controls, acceptable entry conditions, atmospheric readings checked against them, rescue, communication, equipment, other permits, authorization and cancellation. US (29 CFR 1926 subpart AA and 1910.146) and Great Britain (Confined Spaces Regulations 1997, HSE L101) notes. 7 sections and 130 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.
Make it your own: every question is editable
This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.
Details you only enter once
Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.
- Project: the project name
- Site address: the site address, from the space or the project
- Client or owner: the project's customer
Permit, space and purpose
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Site addressShort answerFills in from the site address, from the space or the project
- Client or ownerShort answerFills in from the project's customer
- Location (GPS)Short answer
- Permit date*Date
- Permit prepared by*Short answer
- Permit number*Short answer
- Rules that apply*Choose one
- US: construction (29 CFR 1926 subpart AA)
- US: general industry (29 CFR 1910.146)
- Great Britain: Confined Spaces Regulations 1997
- Other
- Entry employer (whose workers enter)Short answer
- Host employer or owner of the spaceShort answer
- Weather on siteAnswer
- GuidanceUS construction (29 CFR 1926 subpart AA). The entry employer prepares a permit before entry is authorized, and the entry supervisor named on it signs it before entry begins (1926.1205(a), (b)). The permit must identify the items in 1926.1206; this form follows that list. Make the completed permit available to entrants at the time of entry, for example posted at the entry portal (1926.1205(c)).Shown when “Rules that apply” is “US: construction (29 CFR 1926 subpart AA)”
- GuidanceUS general industry (29 CFR 1910.146). The employer prepares a permit before entry is authorized, and the entry supervisor named on it signs it before entry begins (1910.146(e)(1), (2)). The permit must identify the items in 1910.146(f); this form follows that list. Make the completed permit available to entrants at the time of entry, for example posted at the entry portal (1910.146(e)(3)).Shown when “Rules that apply” is “US: general industry (29 CFR 1910.146)”
- GuidanceGreat Britain (Confined Spaces Regulations 1997). No one may enter a confined space to work unless the work cannot reasonably practicably be done without entry, and entry, work and exit must follow a safe system of work (regulation 4). Rescue arrangements must be prepared before entry (regulation 5). The regulations do not set a permit form. HSE's Approved Code of Practice L101 says a permit-to-work is usually required where there is a reasonably foreseeable risk of serious injury, and that it supports the safe system of work rather than replacing it (paragraph 138).Shown when “Rules that apply” is “Great Britain: Confined Spaces Regulations 1997”
- GuidanceUse the confined space rules where the work is done. Enter the acceptable entry conditions from your own permit space program or safe system of work on page 4.Shown when “Rules that apply” is “Other”
- Space to be entered*Short answer
Name or number, and where it is. For example Wet well, Lift Station 4.
- Type of spaceChoose one
- Wet well or lift station
- Utility vault or manhole
- Sewer or large pipe
- Tank, vessel or silo
- Pit, sump or chamber
- Crawl space, void or duct
- Other
- Way in and outShort answer
For example 30 in hatch, fixed ladder to the bottom.
- Purpose of the entry*Notes
The task the permit covers. The permit lasts no longer than this task needs.
- Permit valid on*Date
- From*Time
- Until*Time
- Confined space assessment or program referenceShort answer
The hazard evaluation this permit relies on.
- Rescue plan referenceShort answer
- Photos of the entry point and its surroundingsPhotos
Entry supervisor, attendants and entrants
- Entry supervisor*Short answer
- How to reach themShort answer
Radio channel or phone.
- AttendantsRepeat for each attendant. Each one asks:
- Name*Short answer
- On duty fromTime
- UntilTime
- How entrants are tracked*Choose one
- Named below, with times in and out
- Separate roster or tag board
- Roster or tag board referenceShort answerShown when “How entrants are tracked” is “Separate roster or tag board”
- Authorized entrantsRepeat for each entrant. Each one asks:Shown only when the answers above make it relevant
- Name*Short answer
- CompanyShort answer
- Trained for this entry?Yes or No
- Time inTime
- Time outTime
- e_insideWorked out by the form
- Entrants on the permitWorked out by the formShown only when the answers above make it relevant
- Still shown as insideWorked out by the formShown only when the answers above make it relevant
- Not marked as trainedWorked out by the formShown only when the answers above make it relevant
- CheckAn entrant is not marked as trained for this entry. Check before they go in.Shown only when the answers above make it relevant
Hazards, isolation and equipment
- Hazards of this space*Tick all that apply
- Oxygen deficiency
- Oxygen enrichment
- Flammable gas or vapor
- Hydrogen sulfide
- Carbon monoxide
- Other toxic gas or vapor
- Engulfment or sudden inflow
- Converging walls or sloping floor
- Moving parts or machinery
- Electrical
- Heat
- Fall through the opening
- Traffic near the opening
- Biological (sewage)
- Other
- Other hazards, or more detailNotesShown when “Hazards of this space” includes “Other”
- GuidanceIsolation and controls are made before entry. A check marked Not in place counts below and should be put right before the entry supervisor signs.
- Energy sources locked out and taggedChoose one
Pumps, mixers, valves, electrical feeds.
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Lines blanked, disconnected or double block and bleedChoose one
Product, sewage, gas or water that could flow in.
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Space drained, flushed or cleanedChoose one
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Space ventilated or purged, tested before and afterChoose one
Test before changing the natural ventilation, then again once ventilated.
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Forced ventilation running and its intake in clean airChoose one
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Barriers at the opening against traffic, pedestrians and fallsChoose one
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Lighting suitable for the atmosphereChoose one
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Ladder or safe way in and out in placeChoose one
- In place
- Not in place
- Not checked
- Not applicable
- What needs doing, or why not checkedNotesShown only when the answers above make it relevant
- Controls not in placeWorked out by the form
- Not checkedWorked out by the form
- WarningA control is not in place. Put it right, or record why it is not needed, before entry is authorized.Shown only when the answers above make it relevant
- Isolation points and lock or tag numbersNotes
- If the ventilation stops, how an increase in hazard levels will be detectedNotes
Required on a construction permit (1926.1206(e)). For example continuous 4-gas monitor worn by each entrant, alarm set to the limits on page 4.
Shown when “Rules that apply” is “US: construction (29 CFR 1926 subpart AA)” - Equipment providedTick all that apply
- Gas monitor
- Forced-air ventilation
- Radios or other communications
- Full-body harness
- Retrieval line
- Tripod and winch
- Escape breathing apparatus
- Supplied-air or self-contained breathing apparatus
- Lighting
- Ladder
- Barriers and signs
- Gloves, eye protection and coveralls
- First aid kit
- Other
- Other equipmentShort answerShown when “Equipment provided” includes “Other”
- Gas monitor make and serialShort answer
- Last calibrationDate
- Bump or response test done today?Yes or No
- Gas monitor labelScan a label: serial number, calibration date, sensors
Optional. Scan the data plate or label to capture the numbers.
- Other permits issued for work in this space?Yes or No
For example a hot work permit for welding or cutting.
- Permit type and numberShort answerShown when “Other permits issued for work in this space?” is Yes
Acceptable entry conditions and atmospheric tests
- GuidanceUS definitions. OSHA treats as hazardous an atmosphere with oxygen below 19.5 percent or above 23.5 percent by volume, flammable gas, vapor or mist over 10 percent of its lower flammable limit, or a substance above its OSHA dose or permissible exposure limit (29 CFR 1926.1202 and 1910.146(b)). Test first for oxygen, then combustible gases and vapors, then toxic gases and vapors (1926.1204(e)(3), 1910.146(d)(5)(iii)). Enter the limits your program sets for this space.Shown only when the answers above make it relevant
- GuidanceGreat Britain. HSE ACOP L101 says to test the atmosphere before entry where it might be unsafe to breathe, and to monitor continuously where forced ventilation is used or the work could change the atmosphere, with the testing set by a competent person in the safe system of work (paragraphs 89 to 91). Enter the limits from your safe system of work.Shown when “Rules that apply” is “Great Britain: Confined Spaces Regulations 1997”
- Oxygen at least (%)*Number
From your program or safe system of work.
- Oxygen no more than (%)*Number
- Flammable no more than (% LEL)Number
- H2S no more than (ppm)Number
- CO no more than (ppm)Number
- Other acceptable entry conditionsNotes
For example ventilation running throughout, no rain forecast upstream, pumps locked out.
- Monitoring during entry*Choose one
- Continuous, monitor worn or in the space
- Periodic tests
- Both
- Interval between periodic testsShort answerShown only when the answers above make it relevant
- Entrants offered the chance to watch the tests?Yes or NoShown only when the answers above make it relevant
- Atmospheric test readingsRepeat for each reading. Each one asks:
- Time*Time
- WhenChoose one
- Pre-entry, before ventilation
- Pre-entry, after ventilation
- During entry
- Before re-entry
- Where in the spaceShort answer
Top, middle, bottom, or a point.
- Oxygen (%)*Number
- Flammable (% LEL)Number
- H2S (ppm)Number
- CO (ppm)Number
- Other gas and readingShort answer
- Tested by (name or initials)*Short answer
- r_outWorked out by the form
- r_pre_outWorked out by the form
- Against the acceptable entry conditionsWorked out by the form
- What was done*Notes
For example entrants out, ventilation checked, space retested.
Shown only when the answers above make it relevant
- ReadingsWorked out by the form
- Outside the limitsWorked out by the form
- readings_pre_outWorked out by the form
- WarningA reading was outside the acceptable entry conditions. Record what was done in that reading.Shown only when the answers above make it relevant
- WarningConstruction: the entry supervisor terminates entry. For a temporary condition that does not change the space or create a new hazard, the permit may be suspended and the space fully reassessed before re-entry; otherwise the permit is cancelled (1926.1205(e)).Shown only when the answers above make it relevant
- WarningGeneral industry: the entry supervisor terminates entry and cancels the permit when a condition not allowed under it arises (1910.146(e)(5)).Shown only when the answers above make it relevant
Rescue, communication and authorization
- Rescue arrangement*Choose one
- Non-entry retrieval by the attendant
- On-site entry rescue team
- Off-site rescue service
- Combination
- Rescue and emergency service*Short answer
Who will come.
- How to summon them*Short answer
Number to call, radio channel, equipment to use.
- Rescue service confirmed available for this entry?Yes or No
- GuidanceGreat Britain: suitable and sufficient rescue arrangements must be prepared before anyone enters, including resuscitation equipment where resuscitation is a likely need (Confined Spaces Regulations 1997, regulation 5). Record them in full on the rescue plan.Shown when “Rules that apply” is “Great Britain: Confined Spaces Regulations 1997”
- WarningRescue is not confirmed. Do not authorize entry until it is.Shown when “Rescue service confirmed available for this entry?” is No
- How entrants and the attendant keep in contact*Notes
Voice, radio, rope signals; what happens if contact is lost.
- Anything else entrants need to knowNotes
- Permit posted at the entry point, or otherwise available to entrants?Yes or NoShown only when the answers above make it relevant
- Entrants and attendants briefed on the hazards, conditions and rescue?Yes or No
- Before signingWorked out by the form
- Entry supervisor authorizing entry*Short answer
- Time authorized*Time
- Entry supervisor signature*Signature
- Entry supervisor handoversRepeat for each handover. Each one asks:
- New entry supervisor*Short answer
- Took over atTime
- Signature or initialsSignature
Cancellation and problems found
- Permit status*Choose one
- Cancelled: work complete
- Suspended: reassess before re-entry
- Cancelled: condition not allowed by the permit
- Still open
- CheckSuspension is allowed for construction entries only, for a temporary condition that does not change the space or create a new hazard. Reassess the space fully before re-entry (1926.1205(e)(2)).Shown when “Permit status” is “Suspended: reassess before re-entry”
- TimeTimeShown only when the answers above make it relevant
- All entrants out and accounted for?*Yes or NoShown only when the answers above make it relevant
- Isolations removed or handed back?Yes or NoShown when “Permit status” is “Cancelled: work complete”
- Opening closed or guarded?Yes or NoShown only when the answers above make it relevant
- Problems during the entryNotes
Anything that went wrong or nearly did. These feed the review of the program.
- GuidanceKeep the cancelled permit for at least 1 year, for the review of the permit space program (1926.1205(f), 1910.146(e)(6)).Shown only when the answers above make it relevant
- GuidanceHSE ACOP L101 says to cancel the permit once the work it covers has finished (paragraph 140).Shown when “Rules that apply” is “Great Britain: Confined Spaces Regulations 1997”
- Photos of the space closed upPhotos
Follow-up and sign-off
- Items needing actionWorked out by the form
- ResultWorked out by the form
- ActionsRepeat for each action. Each one asks:
- Action*Notes
- PriorityChoose one
- Before any re-entry
- Before the next entry
- At the program review
- Who will do it*Short answer
- Due byDate
- Status*Choose one
- Open
- In progress
- Done, checked
- Photo when donePhotosShown when “Status” is “Done, checked”
- Actions still openWorked out by the form
- Decision*Choose one
- Closed: no follow-up
- Closed: follow-up actions listed
- Re-entry needs a new permit or reassessment
- Next check or re-inspection dateDate
- Summary for the clientNotes
- Entry supervisor nameShort answer
- Entry supervisor signature*Signature
- Attendant nameShort answer
- Attendant signatureSignature
See it filled in
A completed confined space entry permit report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.
Confined space entry permit FAQs
Who signs a confined space entry permit, and when?
The entry supervisor named on the permit signs it before entry begins, and the completed permit is made available to the entrants at the time of entry, for example by posting it at the entry portal (29 CFR 1926.1205(b) and (c); 1910.146(e)(2) and (3)). The form has the supervisor's signature and time on page 5, and a section for a new entry supervisor's name and signature if the role changes during the entry.
Sources: OSHA 29 CFR 1926.1205, permitting process (construction), eCFR and OSHA 29 CFR 1910.146, permit-required confined spaces (general industry), eCFR.
What oxygen and flammable gas levels make a space hazardous?
OSHA defines oxygen deficient as below 19.5 percent by volume and oxygen enriched as above 23.5 percent, and counts flammable gas, vapor or mist over 10 percent of its lower flammable limit as a hazardous atmosphere, along with any substance over its OSHA exposure limit (29 CFR 1926.1202 and 1910.146(b)). Test oxygen first, then combustible gases, then toxic gases. The form does not set limits of its own: you enter the acceptable entry conditions from your program, and it checks each reading against them.
Sources: OSHA 29 CFR 1926.1202, definitions (construction confined spaces), eCFR, OSHA 29 CFR 1926.1204, permit-required confined space program (construction), eCFR and OSHA 29 CFR 1910.146, permit-required confined spaces (general industry), eCFR.
What happens if a reading goes out of limits during the entry?
The entry supervisor terminates entry. Under the construction rule, the permit is suspended or cancelled and the space fully reassessed before re-entry when the condition is temporary and does not change the space or create a new hazard; otherwise it is cancelled (29 CFR 1926.1205(e)). Under the general industry rule the permit is cancelled (1910.146(e)(5)). The form asks what was done for any out-of-limit reading and keeps the problem on the permit.
Sources: OSHA 29 CFR 1926.1205, permitting process (construction), eCFR and OSHA 29 CFR 1910.146, permit-required confined spaces (general industry), eCFR.
How long must a cancelled permit be kept?
In the US, at least 1 year, so the permit-required confined space program can be reviewed, with any problems during the entry noted on the permit (29 CFR 1926.1205(f) and 1910.146(e)(6)). Each completed form is kept in SiteSurvey with its photos and readings, and can be shared as a PDF report.
Sources: OSHA 29 CFR 1926.1205, permitting process (construction), eCFR and OSHA 29 CFR 1910.146, permit-required confined spaces (general industry), eCFR.
Is a permit to work a legal requirement for confined spaces in the UK?
The Confined Spaces Regulations 1997 do not set a permit form. They say no one may enter a confined space to work unless the work cannot reasonably practicably be done without entry, that entry follows a safe system of work, and that rescue arrangements are prepared before entry (regulations 4 and 5). HSE's Approved Code of Practice L101 says a permit-to-work is usually required where there is a reasonably foreseeable risk of serious injury, and that it supports the safe system of work rather than replacing it.
Sources: Confined Spaces Regulations 1997, regulation 4, work in confined spaces, Confined Spaces Regulations 1997, regulation 5, emergency arrangements and HSE L101, Safe work in confined spaces: Approved Code of Practice and guidance (third edition).
Does this form make an entry safe or compliant?
No. It records the permit: who, where, when, the hazards, the controls, the readings and who authorized the entry. Whether an entry is safe depends on the evaluation of the space, the controls actually in place, trained people, working monitors and a rescue that can really happen. Use the confined space risk assessment and rescue plan forms for those, and the permit on the day.
Related
Related templates
Templates that go with the confined space entry permit form
A confined space assessment recording the task, alternatives to entry, specified hazards, controls, safe-system references and rescue planning requirements.
A site-specific rescue planning record covering the space, credible emergencies, isolation, rescuers, communications, equipment readiness and practice.
Permit for hot work, work at height, confined space entry and other high risk jobs: precautions, isolations, authorisation, hand-back and close-out.
A hot works permit for welding, cutting, grinding and torch-on roofing: precautions before the work, extinguishers and fire watcher, issue and acceptance signatures, the fire watch after the work with timed checks, and hand-back and cancellation.
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