Confined space entry permit template: an authorisation worksheet

Direct answer. A confined-space entry permit is a job-specific authorisation record. It should identify the space, people, work, hazards, isolations, atmosphere testing, ventilation, communication, standby arrangements, rescue capability, time limits and conditions that cancel entry. It is useful only when it sits on top of a competent risk assessment and safe system of work. A blank form is not permission to enter a tank, chamber, sewer or pit. In Great Britain, the Confined Spaces Regulations 1997 require employers to avoid entry where reasonably practicable, use a safe system if entry cannot be avoided, and prepare suitable and sufficient emergency arrangements before entry. A permit can help control and evidence those decisions; it does not itself make the atmosphere safe. HSE confined-space legislation; HSE L101 Approved Code of Practice.

This page gives a copyable permit form, distinct from N5-020’s risk-assessment template. The assessment decides whether the work can be done without entry and what controls are necessary. The permit then records that those controls are actually present for a particular space, crew and period. Do not import US “permit-required confined space” categories into the UK form: OSHA terminology and requirements belong to a separate jurisdiction.

Decide whether the permit is appropriate before issuing it

HSE defines a confined space as a place that is enclosed or largely enclosed and where a reasonably foreseeable specified risk exists, such as fire, explosion, loss of consciousness, asphyxiation or drowning. It need not be small; a large silo can qualify. A tight space without such a risk may still have other hazards and require risk controls. A site label is not a substitute for assessing the actual activity and foreseeable conditions. HSE introduction.

The first question is whether the task can be completed from outside: remote inspection, cleaning, sampling, valve operation or a different design may eliminate entry. If entry is genuinely necessary, the competent planner must consider the atmosphere, connected plant and services, engulfment, flooding, chemicals, temperature, access, communications and rescue. A space that tested safe yesterday may be unsafe today after a line is reopened or work changes the atmosphere. HSE introduction; L101.

A permit is appropriate when the organisation’s safe system uses formal authorisation to control such work. HSE’s ACOP explains how to select precautions for the specific space and task; it does not license one universal form with prefilled gas thresholds. The permit issuer should know the space and have authority to refuse entry. The entrants, attendant and rescue personnel must understand their roles. The person who signs “issued” is not simply checking paperwork: they must confirm the controls and evidence in the field.

Copyable confined-space entry permit

Do not pre-sign. Complete all relevant fields on site. Attach the assessment, safe system, isolation plan, gas-test records and rescue plan. If any critical field is unknown, do not issue.

1. Work and validity

Authorisation limit. This permit applies only to the listed task, space, people and conditions. A shift change, new substance, changed plant state, gas-monitor alarm, loss of ventilation or unexpected inflow triggers stop, exit, reassess and reissue under site procedure. A different supervisor must not assume a predecessor’s signature remains valid.

2. Entry-prevention decision and hazard review

• Can the task be done without entry? [yes/no; alternative considered and reason entry remains necessary]
• Foreseeable specified risks: [oxygen deficiency/enrichment, toxic gas, flammable atmosphere, fire, engulfment, flooding, heat, other]
• Hazards introduced by the job: [welding, coating, cleaning chemical, engine, cutting, agitation, dislodged sediment, other]
• Connected plant, feed lines and adjacent operations: [identify all; do not write “isolated” without a reference]
• Changes since assessment: [weather, process status, material, neighbouring work, prior incidents]
• Competent assessor and review time: [name, role, date/time]

The issuer should compare this section with the actual assessment. A permit that lists “asphyxiation” but has no method for preventing it is incomplete. Remember that the hazards of getting an incapacitated person out may differ from the hazards of routine entry.

3. Controls to verify before entry

Atmosphere results: record the actual readings, instrument units, sampling point and time in an attached log. Use criteria selected by the competent assessor and relevant equipment instructions. This public template deliberately supplies no universal oxygen, flammable-gas or toxic-gas pass numbers: the instrument, substances, task and applicable standard matter. Testing one point at the opening may miss stratification or a changing atmosphere. Decide from the assessment whether continuous monitoring or repeated tests are needed; record what happens when an alarm activates. HSE L101.

4. Rescue and emergency readiness

Regulation 5 requires suitable and sufficient emergency arrangements before anyone enters. HSE’s ACOP warns against relying on public emergency services as the sole rescue arrangement. A rescue worker can be overcome too; do not allow a reflex “go in after them” response. A line and harness are useful only if the access geometry, casualty condition and actual recovery method make them suitable. HSE L101, emergency arrangements.

5. Issue, entry log and close-out

Issue decision: All controls verified? [yes/no] Open items: [none or detail] Permit decision: [ISSUE / DO NOT ISSUE] Issuer signature/date/time: [insert] Supervisor acceptance: [insert] Attendant acknowledgement: [insert].

Monitoring log: [attach readings and alarms]. Suspension/evacuation: [time, trigger, people accounted for, space secured, person notified]. Reissue: [new assessment and permit reference]. Close-out: work complete? [yes/no]; all entrants accounted for? [yes/no]; plant restored only under authorised handback? [record]; residual hazard and next shift informed? [record]; permit closed by / date/time: [insert].

Do not use a signature at issue as evidence of successful close-out. The final handback matters because locks may be removed, process lines reopened, and other teams may assume the vessel is safe for normal service. Where work is suspended, prevent a later crew from walking into the same space under an expired permit.

How to use the permit in a real sequence

Consider an inspection inside a wastewater chamber. The planner first asks if remote inspection can answer the question. If not, the team identifies incoming flow and the possibility of harmful atmosphere, confirms upstream controls and access, selects monitoring, appoints entrants and an attendant, and prepares rescue suitable for the chamber geometry. The issuer verifies those conditions at the actual chamber, not merely from an office screen, and authorises a defined time window. If unexpected flow starts or the monitor alarms, the crew exits and the permit is suspended. It is not revived by waiting a few minutes for a better reading without finding and controlling the cause.

The same form cannot simply be reused for work inside a grain silo. Engulfment, process isolation and retrieval may differ fundamentally. A water chamber, solvent tank and hypoxic fire-suppression room each require their own assessment and rescue method. The form is a reminder to ask and record, not a standard method for entering them.

Common permit failures

• No decision about avoiding entry. The form starts with names, never asks why someone must go in.
• Paper isolation. A valve number is copied without proving the hazardous flow or energy is controlled.
• Single atmospheric reading with no context. No instrument identification, sampling location, time or retest trigger.
• A rescue plan that says “call 999”. Public emergency services may assist but are not the planned on-site capability required by the risk.
• Attendant pulled to another task. The permit lists someone who is no longer positioned or able to maintain contact.
• Permit left live after conditions change. Work, process and crew move beyond its scope.
• No close-out. Entrants are not accounted for or the next shift does not know what state the space was left in.

For teams comparing digital permit workflows, the relevant Complys permit-to-work page should be used only after confirming its current route and deployed confined-space features. Ask for a live demonstration of issue, suspension, reissue and evidence retention. This template does not assert that the product can detect atmospheres, prove isolation, provide rescuers or certify that entry is safe.

Source and claim register — checked 5 October 2026