Form library · Health and safety
Confined space rescue plan template
For people planning and checking confined-space rescue arrangements. Record space and work, rescue arrangements and people and communication. Try the form below, see every question or download a blank PDF or Word copy.
Ready to use from the form library, and every question is yours to edit. Trial from £1, cancel any time.
Try it on your phone
Try it on this phone
Fill in the confined space rescue plan on your phone now
See how the confined space rescue plan looks on your phone
Scan the code with your phone camera. It opens the real form, no sign-up needed.
Open the live example and fill it in, just as your team would on site. No sign-up needed.
See it on this phoneEvery question is editable. Add this form to your account, then change the wording, add or remove questions and options, and make it fit your own jobs.
Can a confined-space rescue plan rely only on the emergency services?
HSE guidance requires adequate emergency arrangements before confined-space work begins and warns against relying on the emergency services alone. Avoid entry where possible; where entry is unavoidable, a safe system of work and suitable rescue arrangements are needed. The plan must reflect the actual space and hazards.
Last updated . Facts checked by the SiteSurvey team on 6 October 2026 against HSE confined spaces legislation and HSE safe work in confined spaces.
Try the confined space rescue plan form live
Answer a few questions and watch it adapt. Your answers are not saved, and any photos you add are deleted within the hour.
This is the real form as your team would use it: questions appear as you answer, scores work themselves out and you can add photos and signatures. No sign-up needed.
Want to see one filled in? See a completed confined space rescue plan report (PDF), made by SiteSurvey from a fictional site visit.
Fill it in on a phone or tablet
Your team completes the confined space rescue plan on site in the SiteSurvey app on iPhone, iPad and Android phones and tablets. The project name and address fill in for them, it works without signal, and it syncs when the device is back online with photos kept against the question they answer.
Customers and subcontractors do not need the app: send them a link and they can fill it in from any browser.
Every question in the confined space rescue plan template
A site-specific rescue planning record covering the space, credible emergencies, isolation, rescuers, communications, equipment readiness and practice. 6 sections and 39 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 or premises address: the site address, from the space or the project
- Client or organisation: the project's customer
- Space ID, location and access details: the space it is opened for
Record details and scope
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Site or premises addressShort answerFills in from the site address, from the space or the project
- Client or organisationShort answerFills in from the project's customer
- Record date*Date
- Person completing the record*Short answer
- CheckThis records a competent team prepared plan. It gives no generic entry or rescue technique and does not qualify anyone to attempt rescue. Do not begin entry where essential arrangements are missing.
- CheckHSE guidance requires adequate emergency arrangements before confined-space work begins and warns against relying on the emergency services alone. Avoid entry where possible; where entry is unavoidable, a safe system of work and suitable rescue arrangements are needed. The plan must reflect the actual space and hazards.
Space and work
- Space ID, location and access details*Short answerFills in from the space it is opened for
- Planned work and reason entry cannot be avoided*Notes
- Confined-space assessment and permit references*Short answer
- Relevant atmosphere, engulfment, machinery and other hazards*Notes
- Isolation and verification arrangements*Notes
Rescue arrangements
- Emergency scenarioRepeat for each emergency scenario. Each one asks:
- Credible emergency scenario*Notes
- Site-specific rescue method prepared by competent people*Notes
- Required people, equipment and access*Notes
- Limitations, stop conditions and escalation*Notes
People and communication
- Rescue coordinator and contact*Short answer
- Rescuers, competence and availability*Notes
- Entry team communication, alarm and emergency call arrangements*Notes
- First aid, medical support and emergency service accessNotes
Readiness and practice
- Practice or exercise reference and dateShort answer
Record the exercise scenario, participants and shortcomings against the approved arrangements. An exercise record is not authority to enter.
- Required rescuers and competent supervision available*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Rescue equipment and relevant checks confirmed*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Communication and alarm arrangements checked*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Method practised and limitations resolved*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Who confirms readiness before entry and howNotes
Actions and review
- Are further actions required?*Choose one
- Yes
- No
- Further actionRepeat for each further action. Each one asks:Shown when “Are further actions required?” is “Yes”
- Action and evidence reference*Notes
- Person responsible*Short answer
- Target dateDate
- Action status*Choose one
- Open
- In progress
- Completed
- Completion evidence*NotesShown when “Action status” is “Completed”
- Outstanding limitations and information to pass onNotes
- Record status*Choose one
- Ready for review
- Further work needed
- Work or use stopped
- Reviewed byShort answer
- Review dateDate
- Author signature*Signature
- CheckSigning records the information entered. It does not itself certify legal compliance, remove a limitation or authorise unsafe work.
Scope and responsibility
This records a competent team prepared plan. It gives no generic entry or rescue technique and does not qualify anyone to attempt rescue. Do not begin entry where essential arrangements are missing.
What a useful entry looks like
Practice or exercise reference and date
Record the exercise scenario, participants and shortcomings against the approved arrangements. An exercise record is not authority to enter.
Exercise scenario covered an incapacitated entrant at the recorded access point. Communication difficulty was logged for resolution before readiness review.
Fictional example of record wording. Use the actual evidence and approved arrangements for your job; this is not a completed report or an instruction to carry out the work.
See it filled in
A completed confined space rescue plan 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 Rescue Plan FAQs
How should I record “Practice or exercise reference and date”?
Record the exercise scenario, participants and shortcomings against the approved arrangements. An exercise record is not authority to enter.
Does this form give rescue instructions?
No. A competent team records the method suitable for the actual space, hazards and equipment. The form must not be treated as training.
What if the rescue equipment is unavailable?
Record the missing arrangement and prevent entry until the necessary arrangements are established. A signature cannot remove that limitation.
Is this the confined-space permit?
No. Link the assessment and permit separately. Rescue planning is one part of the safe system of work.
What are the limits of this template?
This records a competent team prepared plan. It gives no generic entry or rescue technique and does not qualify anyone to attempt rescue. Do not begin entry where essential arrangements are missing.
Can I complete this form on site and share the record?
In the SiteSurvey app the form works offline, with signatures recorded against the questions. Share the completed record as a PDF or a link. Dates and action owners are recorded fields; this form does not send reminders or update other systems.
Related
Related templates
Templates that go with the confined space rescue plan form
A confined space assessment recording the task, alternatives to entry, specified hazards, controls, safe-system references and rescue planning requirements.
A work-at-height rescue planning record linking credible scenarios, competent responders, approved methods, equipment readiness and briefing evidence.
Use this confined space rescue plan form with your team
Add it from the form library in one click, change any question, and every completed form becomes a branded PDF report.
Start your trial →