Confined Space Entry Permit

Author: Yuting

Applied tags:

PTW

Published on: 11/27/2025

Confined Space Entry Permit

SECTION 1: Application by Confined Space Safety Supervisor

Valid From

Valid To

Confined Space Entry by:

COMPANY NAME:

Contractor Coordinator Name:

*Contractor Coordinator Signature:

TOS Name:

*TOS Signature:

Description of Confined Space

BU:

Location:

Machine Code:

Reason for Entry:

Hazards

Hazards:

Others (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Hazard Controls

*LOTO (mechanical, electrical, physical)

*Lines broken & capped

*Double blocked & bleed

*Ventilation

*Area secured (signs, barricade)

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Equipment needed

*Entry equipment (ladders, etc.)

*Harness

*Escape Tripod

*Lifeline

*Lighting (explosion proof/intrinsically safe)

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

PPE

*Hard Hat

*Hearing protection

*Eye protection (other than safety glasses)

*Hand protection (gloves)

*Protective clothing (coveralls, etc)

*Foot protection

*Respiratory protection:

Respiratory protection Type :

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Communication

*Visual

*Voice

*Tug Rope

*Radio

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Entrant and Attendant Information

Entrant 1

Entrant Name :

Badge #:

Time In:

Time Out

Entrant 2

Entrant Name :

Badge #:

Time In:

Time Out

Attendant

Attendant Name :

Badge #:

Phone #:

Add Photos [if any]

Document.pdf

Sheets.xlsx

Additional Permits

Select Additional Permit:

*Link Hot Work Permit [*POC not linking]

*Link Working at Height Permit [*POC not linking]

*Link Line Breaking Permit [*POC not linking]

*Link Special Process Permit [*POC not linking]

Mandatory Conditions For Entry In Place:

All required testing and monitoring is in place and hazards are being controlled or eliminated. [type=checkbox]

Entry is rescue ready – (Rescue equipment located at confined space & rescue team is on stand-by) [type=checkbox]

Attendant(s) is identified and is in place.

Pre Entry meeting has taken place.

Contractor Documents Attached:

Rescue Plan

Training certificate for Entrant - Perform Work in Confined Operation

Training certificate for Attendant - Perform Work in Confined Operation

Training certificate for Supervisor - Supervise Work in Confined Space Operation

Training certificate for Assessor - Supervise Work in Confined Space Operation

Calibration Certificate of monitoring instrument

*Select/Attach relevant files

Document.pdf

Sheets.xlsx

Confined Space Safety Supervisor (Contractor) Name

* Confined Space Safety Supervisor (Contractor) Signature

Contact of Confined Space Safety Supervisor Phone #

SECTION 2: Evaluation by Confined Space Safety Assessor

Atmospheric Testing

Continuous monitoring required if potential exists, for atmosphere to change. If assessment determines there is absolutely no potential for atmospheric hazards, check NA box minimally.

Frequency of Test

Testing Performance and Results

Reading No.	Time of Reading	O2 (Limits: 19.5 – 23.5%)- Results:	Combustible Gas (Limits: > 10% LEL)- Results:	CO (Limits: > 25 ppm)- Results:	H2S (Limits: > 10 ppm)- Results:	Others (e.g.: HF gas). Please specify:-	Others - Result
-	-	-	-	-	-	-	-

Edit Table

*Confined Space Assessor Endorsement

Instruments Used and Calibration Details

Instruments Used

Model:

Serial No.:

Calibration Details

Expiration Date:

*Bump Test Check Performed?

Contact of Confined Space Safety Assessor

Phone

Confined Space Safety Supervisor (TOS) Name

*Confined Space Safety Supervisor (TOS) Signature

SECTION 3: Approval by Confined Space Authorised Manager

Remarks (if any):

Confined Space Authorised Manager Name

*Confined Space Authorised Manager Signature

Confined Space Authorised Manager Phone #

Download PDF
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Confined Space Entry Permit

SECTION 1: Application by Confined Space Safety Supervisor

Valid From

Valid To

Confined Space Entry by:

COMPANY NAME:

Contractor Coordinator Name:

*Contractor Coordinator Signature:

TOS Name:

*TOS Signature:

Description of Confined Space

BU:

Location:

Machine Code:

Reason for Entry:

Hazards

Hazards:

Others (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Hazard Controls

*LOTO (mechanical, electrical, physical)

*Lines broken & capped

*Double blocked & bleed

*Ventilation

*Area secured (signs, barricade)

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Equipment needed

*Entry equipment (ladders, etc.)

*Harness

*Escape Tripod

*Lifeline

*Lighting (explosion proof/intrinsically safe)

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

PPE

*Hard Hat

*Hearing protection

*Eye protection (other than safety glasses)

*Hand protection (gloves)

*Protective clothing (coveralls, etc)

*Foot protection

*Respiratory protection:

Respiratory protection Type :

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Communication

*Visual

*Voice

*Tug Rope

*Radio

*Other:

Other (Please Specify):

Add Photos [if any]

Document.pdf

Sheets.xlsx

Entrant and Attendant Information

Entrant 1

Entrant Name :

Badge #:

Time In:

Time Out

Entrant 2

Entrant Name :

Badge #:

Time In:

Time Out

Attendant

Attendant Name :

Badge #:

Phone #:

Add Photos [if any]

Document.pdf

Sheets.xlsx

Additional Permits

Select Additional Permit:

*Link Hot Work Permit [*POC not linking]

*Link Working at Height Permit [*POC not linking]

*Link Line Breaking Permit [*POC not linking]

*Link Special Process Permit [*POC not linking]

Mandatory Conditions For Entry In Place:

All required testing and monitoring is in place and hazards are being controlled or eliminated. [type=checkbox]

Entry is rescue ready – (Rescue equipment located at confined space & rescue team is on stand-by) [type=checkbox]

Attendant(s) is identified and is in place.

Pre Entry meeting has taken place.

Contractor Documents Attached:

Rescue Plan

Training certificate for Entrant - Perform Work in Confined Operation

Training certificate for Attendant - Perform Work in Confined Operation

Training certificate for Supervisor - Supervise Work in Confined Space Operation

Training certificate for Assessor - Supervise Work in Confined Space Operation

Calibration Certificate of monitoring instrument

*Select/Attach relevant files

Document.pdf

Sheets.xlsx

Confined Space Safety Supervisor (Contractor) Name

* Confined Space Safety Supervisor (Contractor) Signature

Contact of Confined Space Safety Supervisor Phone #

SECTION 2: Evaluation by Confined Space Safety Assessor

Atmospheric Testing

Continuous monitoring required if potential exists, for atmosphere to change. If assessment determines there is absolutely no potential for atmospheric hazards, check NA box minimally.

Frequency of Test

Testing Performance and Results

Reading No.	Time of Reading	O2 (Limits: 19.5 – 23.5%)- Results:	Combustible Gas (Limits: > 10% LEL)- Results:	CO (Limits: > 25 ppm)- Results:	H2S (Limits: > 10 ppm)- Results:	Others (e.g.: HF gas). Please specify:-	Others - Result
-	-	-	-	-	-	-	-

+ Add New Row

*Confined Space Assessor Endorsement

Instruments Used and Calibration Details

Instruments Used

Model:

Serial No.:

Calibration Details

Expiration Date:

*Bump Test Check Performed?

Contact of Confined Space Safety Assessor

Phone

Confined Space Safety Supervisor (TOS) Name

*Confined Space Safety Supervisor (TOS) Signature

SECTION 3: Approval by Confined Space Authorised Manager

Remarks (if any):

Confined Space Authorised Manager Name

*Confined Space Authorised Manager Signature

Confined Space Authorised Manager Phone #