A free permit for entry into a site-classified permit-required confined space. It covers hazards, isolation, testing, entrants, attendants, rescue, authorization and cancellation. Take the fillable PDF to print and post at the portal, the Word version to adapt the wording to your site, or the Excel workbook, which puts the monitoring log and entrant roster on their own tabs.
Get it free in PDF, Word or Excel for preparing, authorizing, monitoring and closing permit-required confined-space entry.
Two working pages plus a separate guidance page. Review every section included in the fillable PDF before you download it.
Two working pages plus a separate guidance page. Review every section included in the fillable PDF before you download it.
A confined space entry permit is the written authorization for entry into a permit-required confined space. It records the space, purpose, hazards, controls, acceptable entry conditions, entry team, rescue arrangements, authorization and cancellation.
The permit is used only after the employer’s written program has evaluated and classified the space. It is the record of one authorized entry, not the program itself.
Check that the site’s written program has evaluated and classified the space before anyone opens a permit.
Record the purpose, work description, entry team and the duration the permit will remain valid for.
Identify hazards, apply the controls, then test oxygen, combustibles and toxics in that order.
Verify communications, equipment and that the rescue service is capable, available and reachable.
The entry supervisor signs, and the permit is posted at the entry portal or made available by equally effective means.
Log results, account for everyone, cancel the permit and retain it for at least one year.
The template is built around OSHA 1910.146. OSHA also publishes sample confined-space permits, but employers must create a process that addresses their actual spaces and hazards.
OSHA 1910.146. Permit-required confined spaces for general industry: the program, the permit, the entry roles and rescue.
Federal general industry. It does not cover construction entry under 29 CFR 1926 Subpart AA.
Not the whole program. It does not replace the full written permit-space program, training records or rescue-team drills.
This template is provided as general guidance. Site-specific procedures and the requirements of the authority having jurisdiction, insurer and other applicable authorities take precedence. Have a competent person review and adapt the template before use. Confirm citations against the standard editions your site holds. This is safety information, not legal advice.
The baseline permit-to-work form for non-routine work that needs authorization and closeout.
View template PermitRequired alongside this permit whenever hot work will take place inside the space.
View template ProcedureThe equipment-specific procedure behind the Part E energy isolation record.
View templateNeed a live view of permits, entrants, approvals, isolations and closeout status? Zentri digitizes the full permit lifecycle.