Confined Space Permit to Work
Author: Novade Solutions
Manages safe work in confined spaces, including hazard checks and proper PPE. The workflow supports approvals, revocation, rejection, and extensions.
Confined Space Permit to Work
General Information
*Work Location Photo
Items to check
Select (✓) to indicate OK; (✘) to indicate not OK; (N/A) for conditions not required.
Ventilation and lighting are provided and adequate.
Personnel carrying out work are competent with relevant required training (e.g., CCSA, Manhole Supervisor).
Confined space attendant appointed and assigned at the entrance.
Proper PPE provided and used correctly (e.g., safety harness, lifeline, respiratory protection).
Appropriate signage posted at the entrance and attendance signboard provided.
Area purged and flushed thoroughly before commencement of work.
Safe means of access and egress provided.
Electrical tools of flame-proof and approved types used.
Sufficient rescue equipment provided and properly maintained.
Gas Test Reading
Gas Test Reading
| Date & Time of Gas Test: | Read by | Gas Meter Serial No: | % of Oxygen [19.5% - 23.5%]: | % LEL [<10%]: | Carbon Monoxide [<25ppm]: | Hydrogen Sulphide [<10ppm]: |
|---|---|---|---|---|---|---|
| - | - | - | - | - | - | - |
Remarks
Extension
*Is an extension required for this PTW?
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Confined Space Permit to Work
General Information
*Work Location Photo
Items to check
Select (✓) to indicate OK; (✘) to indicate not OK; (N/A) for conditions not required.
Ventilation and lighting are provided and adequate.
Personnel carrying out work are competent with relevant required training (e.g., CCSA, Manhole Supervisor).
Confined space attendant appointed and assigned at the entrance.
Proper PPE provided and used correctly (e.g., safety harness, lifeline, respiratory protection).
Appropriate signage posted at the entrance and attendance signboard provided.
Area purged and flushed thoroughly before commencement of work.
Safe means of access and egress provided.
Electrical tools of flame-proof and approved types used.
Sufficient rescue equipment provided and properly maintained.
Gas Test Reading
Gas Test Reading
| Date & Time of Gas Test: | Read by | Gas Meter Serial No: | % of Oxygen [19.5% - 23.5%]: | % LEL [<10%]: | Carbon Monoxide [<25ppm]: | Hydrogen Sulphide [<10ppm]: |
|---|---|---|---|---|---|---|
| - | - | - | - | - | - | - |
Remarks
Extension
*Is an extension required for this PTW?