Permit #: _______________

Confined Space Entry Permit

Per 29 CFR 1910.146 — Permit-Required Confined Spaces | EHS Community Template

⚠ PERMIT-REQUIRED CONFINED SPACE ENTRY. This permit must be completed and signed by the Entry Supervisor before any entrant enters the space. The permit is valid only for the date and duration listed. Cancel immediately if conditions change or the job scope changes.

SECTION 1 — SPACE & JOB IDENTIFICATION

Space Name / Location

Space Description / ID

Purpose of Entry

Permit Date

Valid From (Time)

Permit Expires (Time)

Maximum # Entrants

SECTION 2 — HAZARDS PRESENT IN THIS SPACE

Potential Hazard	Present? (Y/N)	Control Measure
Oxygen-deficient atmosphere (<19.5%)
Oxygen-enriched atmosphere (>23.5%)
Flammable gas / vapor (>10% LEL)
Toxic air contaminant (above PEL)
Engulfment / flooding hazard
Internal configuration / entrapment
Mechanical / energized equipment
Thermal (heat / cold stress)
Other: _______________________

SECTION 3 — ATMOSPHERIC TESTING LOG

Before entry, test in this order: oxygen, then combustible gases and vapors, then toxic gases and vapors (29 CFR 1910.146(d)(5)(iii)). During entry, test or monitor as often as needed to confirm acceptable conditions are maintained (d)(5)(ii); monitor continuously where the space cannot be isolated (d)(5)(i). Continuous monitoring, and testing at several levels where the atmosphere may be stratified (Appendix B to 1910.146), are good practice. Column limits are US federal OSHA values; Cal/OSHA's are lower (8 CCR 5155: CO 25 ppm and H₂S 10 ppm 8-hour PELs) and Canadian provinces set their own, so use the limits for your jurisdiction.

Time	Tested By	Instrument / Cal. Date	O₂ % (19.5–23.5%)	LEL % (<10%)	CO ppm (US PEL: 50, 8-hr TWA)	H₂S ppm (US ceiling: 20)	Other	Safe to Enter?

SECTION 4 — ISOLATION & ENERGY CONTROL

LOTO Procedure # / Equipment Isolated

Lines Blanked / Blinded

Ventilation Provided (Type / CFM)

SECTION 5 — REQUIRED PPE

Respiratory Protection

Retrieval / Rescue Equipment

Other PPE Required

SECTION 6 — PERSONNEL

Role	Signature	Time In	Time Out
Entry Supervisor		—	—
Attendant (Outside)		—	—
Authorized Entrant 1
Authorized Entrant 2
Rescue Service Contact	—	—	—

Rescue Service Phone

SECTION 7 — RESCUE PLAN

Non-Entry Rescue Method (preferred)

Emergency Contact / 911 Access Point

PERMIT CANCELLATION / CLOSURE

Reason for Cancellation or Completion

Cancelled / Closed By

Time

Cancelled permits must be retained for at least 1 year per 29 CFR 1910.146(e)(6) so that failures can be reviewed during the annual review of the confined space program.

This template is provided for educational purposes by EHS Community (ehscommunity.com). It does not constitute legal advice. Reference: 29 CFR 1910.146 — Permit-Required Confined Spaces.