Confined space entry permit — pre-entry checklist
Checks to complete on each confined space permit before anyone enters: isolation, cleaning and ventilation, oxygen, flammable and toxic gas readings, respiratory protection, attendant, rescue plan and equipment, communication and lighting.
18 itemsWorkplace safetyVersion 1Updated
This template covers a high-hazard activity. Adapt it to your site’s written procedures, your equipment and local regulations, and have it approved by a competent person before use. When imported, it lands for review: a checklist as a draft, a procedure as inactive.
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Category: Permit — pre-work checklist
- Permit type: Confined Space
- Filled in on each permit concerned, before the work starts.
Imported as a draft: it is not used until you review it and click Activate on the HSE template. Once activated, it is used on every new permit of this type and replaces the checklist in use.
Checklist items
Entry cannot be avoided
The work cannot be done from outside the space (remote tools, inspection camera, cleaning from the opening).
Pass / FailCritical: a failure blocks the permitThe space is isolated from every energy and every substance
Lines blanked, disconnected or isolated by double block and bleed (one closed valve is not enough), agitators, drives and heating locked out.
Pass / FailCritical: a failure blocks the permitThe space has been emptied and purged or ventilated, and cleaned as far as possible from outside
Pass / FailCritical: a failure blocks the permitThe gas detector has been bump-tested and is within its calibration date
It stays with the entrants to monitor the atmosphere continuously during the entry.
Pass / FailCritical: a failure blocks the permitOxygen (% vol)
Measured from outside, at the top, middle and bottom. Typical guidance: 19.5 to 23.5 %. Apply the range of your site procedure.
NumberRequiredFlammable gases (% LEL)
Typical guidance: below 10 % of the lower explosive limit. Apply the limit of your site procedure.
NumberRequiredHydrogen sulphide, H₂S (ppm)
Below the exposure limit that applies on your site.
NumberRequiredCarbon monoxide, CO (ppm)
Below the exposure limit that applies on your site.
NumberRequiredForced ventilation in place and running
Where the permit requires it, with the air intake away from exhausts. Never ventilate with pure oxygen.
Pass / FailoptionalRespiratory protection required
ChoiceRequired- None
- Escape set carried
- Breathing apparatus or supplied air
An attendant is posted at the entry for the whole entry
Trained, in constant contact with the entrants, with no other task, and never entering to attempt a rescue.
Pass / FailCritical: a failure blocks the permitThe rescue plan is in place and its equipment is at the entry
Tripod or davit with winch, harnesses, rescuers available within the time set by the plan, emergency number known.
Pass / FailCritical: a failure blocks the permitEntrants are trained, fit for the task and wear the equipment the permit requires
Pass / FailCritical: a failure blocks the permitCommunication between the entrants and the attendant has been tested
Pass / FailCritical: a failure blocks the permitLighting and tools are suited to the space
Safety extra-low voltage or battery equipment, and certified for explosive atmospheres where one may form.
Pass / FailCritical: a failure blocks the permitAn entry log records every person going in and out
Pass / FailoptionalPhoto of the prepared entry
PhotooptionalAdditional precautions or remarks
Free textoptional
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Licence
Official FreeMaint template, free to use and adapt inside your FreeMaint workspace. An adaptation may be shared in the library under CC BY 4.0; its page then credits this template.
Templates are general guidance. They do not replace the manufacturer’s instructions, your site procedures or applicable regulations.
Equipment: Workplace safety
Industries: Manufacturing, Energy and utilities, Food and beverage, Construction
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