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Confined space entry permit template
A confined space entry permit is the written permission to enter a tank, vessel, pit, silo, duct or similar space that is big enough to enter, has limited ways in and out, and is not made for people to stay in. It records the space and the job, the hazards, how the space is isolated and ventilated, the air readings before and during entry, who is inside, who is the attendant outside, how they talk, and how a rescue would work, and it is cancelled when the work ends or conditions change. This template has five portrait pages: the permit with 20 checks in four groups, people, communication and rescue with sign-offs, an air test log and an entry and exit log with cancellation, one page of guidance, and a worked example of a mixer vessel clean-out with one ventilation pause. The acceptable air ranges are left blank on purpose because they come from the rules that apply to you. The Excel version has a permit sheet that says whether it is ready, an air test log that marks each reading in or out of range against the ranges you type in, an entry log that shows who is inside, a permit register that flags a permit left open, and a list of your spaces with a yearly review date. It is a general starting point, not legal advice.
Free to use: print it, copy it and edit it for your team. Enter your name and work email once to download.
Fields for permit number, space, purpose and people, a tick list of hazards, and a table of checks on isolation, atmosphere, people and rescue with Yes and N/A boxes.Permit with 20 checksHazards identifiedRescue plan and communicationAir test logEntry and exit logCancellationSpace listWorked example
When to use it
When to use a confined space entry permit
- Before anyone enters a tank, vessel, mixer, pit, sump, silo, duct or vault for cleaning, repair, inspection or any other job.
- When your safety procedure, an insurer or a customer asks for a permit, an air test record and an entry log for every entry.
- To list the spaces on a site, check which need a permit and keep the permits, tests and rescue plans for each in one place.
- After a near miss in a space, to tighten the isolation, the testing or the rescue arrangements.
- Not for work that can be done from outside the space, and not as a replacement for training: everyone on the job needs it first.
How to fill it in
- 1
Identify the space and the hazards
Name the space, say what the job is, and tick the hazards: too little or too much oxygen, flammable or toxic gas, engulfment, moving parts, stored energy, heat, noise and difficult exit. If the job can be done from outside, do not enter.
- 2
Isolate, clean and ventilate
Lock out power and moving parts, blank or close and lock lines that could bring material in, empty and clean as far as the job needs, let hot surfaces cool, and start ventilation with air from a clean place. Tell everyone nearby and barrier the entrance.
- 3
Test the air before entry
A trained person tests oxygen, flammable and toxic readings with an instrument that has been checked. Write the readings in the log against the ranges your rules set. If any reading is out of range, nobody goes in.
- 4
Name the attendant and agree communication and rescue
The attendant stays outside the whole time, has no other job, knows who is inside and can talk to them. The rescue plan and equipment are ready at the opening before anyone enters. The attendant does not go in to rescue.
- 5
Sign, enter and keep testing
The entry supervisor, the attendant and the entrants sign. The attendant logs each person in and out. Keep testing at the interval on the permit, and leave at once if an alarm sounds, ventilation stops or anyone feels unwell.
- 6
Cancel the permit
When the work is done, conditions change or anyone has a doubt, everyone comes out, the attendant counts them and the permit is cancelled with the time and the reason. A new permit is needed to enter again.
What's on the permit
The 20 checks on the confined space entry permit
Four groups, checked before entry and kept up during the work. On the permit each line is marked Yes or N/A with initials, and a check that is not in place means nobody enters. The air ranges are left for you to set from your local rules.
Isolation and preparation
Before anyone goes near the opening
- 1The space is identified and the work is something that cannot be done from outside
- 2Power, drives and moving parts are isolated and locked out, and the lock is checked
- 3Pipes and lines that could bring in material, gas or steam are blanked, disconnected or closed and locked
- 4The space has been emptied, cleaned or purged as far as the job needs, and hot surfaces have cooled
- 5Other people who work nearby or upstream have been told, and the entrance is barriered and signed
Atmosphere and ventilation
Test before entry and keep testing
- 6The air has been tested by a trained person before entry with an instrument that has been checked, and the readings are in the log
- 7Oxygen, flammable and toxic readings are inside the ranges your site has set, and the ranges are written on this permit
- 8Ventilation is running and its air comes from a clean place; what happens if it stops is agreed
- 9Testing continues during the work, either continuously or at the interval written on this permit
- 10Anyone entering leaves at once if an alarm sounds or ventilation stops
People, communication and rescue
Who is in, who is outside and how they get help
- 11Each entrant and the attendant are trained for this space and know the hazards
- 12An attendant is stationed outside the whole time, has no other task and keeps count of who is inside
- 13Entrants and the attendant can talk to each other the whole time, and the way is written on this permit
- 14A rescue plan is agreed and the equipment is at the opening; the rescuers can reach the space quickly
- 15The attendant will not enter the space to rescue, and knows how to call for help
- 16A harness and retrieval line are used where the space allows, so a person can be pulled out without anyone going in
The work and protection
What goes in with the entrants
- 17Lights, tools and equipment are suitable for the atmosphere and the space, with low-voltage or protected lighting where needed
- 18Protective equipment is the right type for the hazards and has been checked
- 19Hot work in the space has its own permit in addition to this one
- 20Entrants and the attendant sign in and out of the space on the entry log
A filled-in example
Illustrative, not a benchmarkAn example: a clean-out of a mixer vessel, with two entrants and one attendant. The permit and readings are invented, and the ranges are examples only.
- Before entry the power was locked out, the pipes blanked and the fan running. The first test at 08:30 was in range: oxygen 20.9, no flammable gas, no toxic gas. Entry was at 08:35.
- At 09:10 the ventilation fan tripped. The attendant called both entrants out at once, and both were out by 09:11.
- The fan was restarted at 09:25, and the air was tested again at 09:27: oxygen 20.2, in range but lower than before. Re-entry was at 09:30 with the fan at full speed.
- The last test at 10:00 was in range. Work finished, both entrants came out, and the permit was cancelled at 10:05 with the reason job complete.
Three tests over 90 minutes, all in range, and a pause that was recorded rather than hidden. The entry log shows 132 entrant-minutes inside in two entries each.
Common mistakes
Testing once, at the start
Air changes while people work, and a fan can stop. Keep testing at the interval on the permit, or monitor continuously, and leave at once if ventilation stops.
Using the emergency number as the rescue plan
A plan has to be ready at the opening before entry: who goes, with what equipment, how quickly. Nobody should go in after a person in trouble without it.
An attendant who is also working
The attendant's only job is to watch, count and call for help. An attendant who walks away or goes in has stopped being the attendant.
Copying ranges from another site's form
The acceptable readings come from the rules that apply to you and your procedure. Write them on the permit before the first test.
Leaving the permit open
A permit still open after the work ends means the space may be entered on stale conditions. Cancel it with a time and a reason, and check the register for any that are still open.
Download the template
Free to use: print it, copy it and edit it for your team. Enter your name and work email once to download.
Run this template in LeanSuite
In LeanSuite each LOTO procedure is a digital form with photo-verified isolation steps, it opens only for people with a valid Authorized Employee certification for that machine, and Document Management gives each procedure an owner and a yearly review date.
See it in a 45-minute demoFAQ
Confined space entry permit template: common questions
A space that is large enough for a person to enter, has limited or restricted ways in and out, and is not designed for continuous occupancy. Tanks, vessels, pits, silos, ducts and vaults are common examples. Your procedure and local rules define the cases that apply to your site.
A written authorisation to enter a confined space that records the space and the job, the hazards, how the space is isolated and ventilated, the air test results, who enters and who is the attendant, and the rescue arrangements. It is cancelled when the work ends or conditions change.
That is set by the rules and standards that apply to your site, not by this template. It leaves the oxygen, flammable and toxic ranges blank for you to fill in, and the Excel air test log marks each reading against the ranges you type.
The attendant stays outside the whole time, keeps count of who is inside, keeps in contact with them, watches for changes in conditions, orders an exit if needed and calls for help. The attendant does not enter the space to rescue anyone.
No. It is a general starting point. Adapt it to the law that applies to your site and to your own confined space procedure, and have your safety professional review it.
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- Nemawashi template (stakeholder plan)Plan the one-to-one conversations before a decision: who to talk to in what order, their concerns, what changed and where they stand.
- Heijunka box planner (production leveling)Weekly demand turned into containers a day, takt, pitch and slots, a leveled sequence of products and the heijunka box, with a check that the changeovers fit.
- 4M change management sheet (change point)A shift log of every change to Man, Machine, Material, Method or Design, the extra checks after it and when normal checks resume, with a change point board.
- Future state value stream map worksheetThe eight future-state questions worked through in order: takt, pitch, flow, supermarkets, the pacemaker and the mix, with an EPEI check and current against future lead time.
- Value stream plan (VSM action plan)The future-state map cut into loops, each with an objective and a measurable goal, and its kaizen bursts turned into owned, dated projects on a 12-month timeline.
- Kaizen project plan (Gantt chart)One improvement project as a Gantt chart: tasks by phase with owners, predecessors and working days, a 16-week grid, milestones and a status from planned against actual % done.
- Histogram templateReadings, bins set by the square root rule, a tally and counts, the spec limits drawn and the share out of spec, with the common shapes explained.
- Scatter diagram templateUp to 50 pairs with a group code, r and R², the least squares line, the quadrant count and r for each group.
- Gauge calibration logA gauge register with next due dates and status, a calibration record with as-found and as-left readings, and the steps when a gauge fails.
- Escalation matrix templateWho is called for each type of issue and after how long, with severity rules, contacts and an escalation log.
- Visual management audit checklist29 checks of whether anyone can tell normal from abnormal at a glance, scored by group, with a trend and actions.
- Quality alert formA quality alert to post at the line, a sign-off sheet for every shift, and a log of open, expired and closed alerts.
- TQM self-assessment templateThe eight TQM principles in 24 statements you can check on the floor, scored 0 to 4 by several people, with the spread, the top 3 gaps and an action plan.
- Employee recognition program templateDesign a recognition program on one page, then run it: points per action, prizes, budget, a points ledger, a monthly leaderboard and a fairness check by team and shift.
- Lean transformation roadmapA plant-wide lean program on one sheet: six phases with exit criteria, six workstreams by quarter over 24 months, the model line, metrics with baseline and target, cadence and risks.
- Obeya room plannerPlan the walls, owners, cadence, agenda and rules of an obeya, then run the weekly review of KPIs, problems, actions and milestones.
- Paper forms inventory (paperless manufacturing worksheet)Every paper form, checklist and log in one list: hours a month, who acts on it, how long the paper waits, and which forms to move first.
- Continuous improvement software evaluation scorecardCompare CI software vendors: a must-have gate, eight weighted criteria scored 1 to 5, points out of 100 and a rank, with a demo script and reference questions.
- Lean principles assessment templateThe five lean principles as 25 things you can see on one value stream, answered yes, partly or no on a walk, with a score per principle, the next step and a trend over walks.
- Employee engagement survey templateA short anonymous pulse survey for shop floor staff: 14 statements in six drivers, two open questions, results by driver and team, and the actions.
- Hansei reflection sheet (lessons learned)A written look back at one finished project, event or launch: goals against results in numbers, causes rather than blame, lessons to keep or change, and where else they apply.
- Daily kaizen routine boardA team's 10 to 15 minute daily routine at the board: one problem from each person, small fixes with one owner, counted every week.
- Quality circle meeting recordA circle's charter, a one-page record for each meeting and a problem register that follows every problem from selected to closed or escalated.
- Operational excellence assessment templateThe ten principles of operational excellence as 30 behaviors and practices you can see, scored 1 to 5 by several people, with the spread, the three lowest principles and an action plan.
- Scrum meeting agenda templateTimed agendas for the five scrum meetings, a sprint planning sheet, a retrospective sheet, and an Excel sprint backlog with a burndown.
- Toyota Production System (TPS) house templateThe TPS house for one plant or value stream: roof, two pillars and foundation, with what you do today, the evidence, a status and the next step for each element.
- EPEI and batch size calculatorHow often each part can come round on a shared machine (EPEI) and how big each batch must be, from demand, cycle times and changeovers, now and after SMED.
- People, process, technology (PPT) assessmentCheck one change before go-live: 18 people, process and technology statements scored 1 to 4 by the people who will use it, the lowest element and the actions.
- Process capacity sheet templateEach machine in a part's routing with manual, auto and tool change time, its capacity per shift, and the step that limits the cell against demand.
- Jidoka worksheet (stop at abnormality)For one line or cell, every abnormality that should stop the work: how it is detected, how the work stops, who is called, the immediate fix and the root cause step, plus a log of real stops.
- Team charter templateA one-page charter for a standing team: purpose, scope, roles, the KPIs it owns, which decisions it makes itself, norms and cadence.
- Chaku-chaku line plannerPlan a load-load cell: time each machine, load and walk, check that every machine is ready when the operator comes back, compare the cell cycle with takt and size the crew.
- Standard operating procedure (SOP) templateA full SOP in the hierarchical step format, from purpose and scope to the steps, records, revision history and approvals, with review checks and an SOP register.
- Process improvement method selectorEight questions about one problem, an example rule that suggests a method and a matrix of nine methods: when each fits, the usual team and time, and the template to start with.
- X-bar and R control chart template25 subgroups with means and ranges, control limits from A2, D3 and D4, signal flags, both charts and a reaction log.
- Gage R&R study sheet10 parts, 2 or 3 appraisers, 2 or 3 trials: EV, AV, GRR, PV, %GRR and ndc by the average and range method.
- Root cause analysis templateOne report from problem statement to proof: containment, evidence, analysis, verified causes, actions and the effectiveness check.
- Quality control pillar 90-day model area planThirteen weeks from the QA matrix to the QM matrix on one model area, a KPI board, the day-90 gate and expansion waves.
- Environment and energy pillar 90-day model area planThirteen weeks from waste and energy maps to area standards on one model area, a KPI board, the day-90 gate and expansion waves.
- Focused improvement 90-day model area planThirteen weeks from the loss Pareto to standardized fixes on one model line, a KPI board, the day-90 gate and expansion waves.
- Logistics and customer service pillar 90-day model area planThirteen weeks from the current-state map to pull on one model value stream, a KPI board, the day-90 gate and expansion waves.
- People development pillar 90-day model area planThirteen weeks from the skills matrix to trained cover on critical tasks in one model area, a KPI board, the day-90 gate and expansion waves.
- Cost deployment pillar 90-day model area planThirteen weeks from the loss map to costed, ranked projects in one model area, a KPI board, the day-90 gate and expansion waves.
- Moving from Excel to one system checklistA 34-point checklist and a file inventory for moving trackers from spreadsheets to one system: keep, move, connect or retire, clean, pilot, run both, retire.
- Prioritization matrix templateScore up to 20 improvement ideas on weighted criteria, rank them, test the ranking with equal weights and place each one on an effort and benefit grid.
- Cost per unit worksheet (manufacturing cost per good unit)One product's cost per good unit by materials, labor, machine and overhead, the gap to target, and which cost lever is worth most a year.
- Digital manufacturing readiness assessmentScore 24 statements on process, technology and people from 0 to 4, check the balance between them and rank the gaps by what matters in your plant.
- Manufacturing KPI dashboard templateWeekly plant numbers in, 14 KPIs out: OEE and its parts, first pass yield, scrap, on-time delivery, recordable rate, cost and absence, each against a target.
- Error-proofing verification log (daily master-sample check)Each poka-yoke device proved every day or week with a known-bad sample, with missed checks counted and the hours and parts at risk worked out when one fails.
- Defect catalogue template with boundary samplesEvery defect with a definition, a class and the reason for it, measured accept and reject limits by zone, boundary samples, a defect log with DPU and Pareto, and an inspector agreement check.
- I-MR chart template (individuals and moving range)Up to 100 single readings with moving ranges, limits from a baseline, five run-rule flags, both charts, a second phase and a reaction log.
- Kaizen event preparation checklistEverything that has to be ready before a kaizen event and done after it: 44 items with owners and due dates from 6 weeks before day 1 to 30 days after, five go or no-go gates and a day-by-day agenda.
- Attribute control chart template (p, np, c and u charts)p, np, c and u charts in one workbook: a chart selector, a sample size check, limits for each subgroup, signal flags and four worked examples.
- Tier 2 meeting agenda and escalation sheetA 15-minute tier 2 agenda in ten timed blocks, fixed roles and rules, escalation triggers with time limits, and a log that ages every escalation and sends the answer back down.
- Mock recall template: traceability exercise worksheetTrace a finished lot back to every input lot and forward to every first customer, reconcile the quantities against a tolerance and time it against your target.
- ISO 9001 internal audit checklist (production area)46 audit questions for the production floor in 11 processes, each with its ISO 9001:2015 clause, what evidence to look for and the sample to take, plus five defined grades, a findings log, a finding report and a summary by clause.
- Plan for every part (PFEP) templateOne row per part: supplier, pack, container, usage, lead time and locations, with ABC classes, market and line kanban counts and a lineside space check.
- Food plant GMP inspection checklist (21 CFR 117 subpart B)55 checks in the order of 21 CFR 117 subpart B, each citing its paragraph and saying what to look at, with a grade, finding, owner and due date; results by section and grade, a walk route and a bakery example.
- Master sanitation schedule with pre-op verificationA master list of cleaning tasks by area and equipment with frequency, chemical, lockout, who and next due date, a weekly on-time count, and the pre-operational verification log with a release step.
- Changeover matrix templateA from-to matrix of changeover minutes with the clean each transition needs (allergen, colour, format), and a weekly planner that totals the order and suggests a shorter one.
- Measurement uncertainty budget templateA GUM uncertainty budget: Type A and B rows, divisors by distribution, sensitivity coefficients, uc, νeff, k from the t-table, U, TUR and a guard band check.
- Video time study filming checklistA pre-shoot checklist and shot log for filming a time study on video: camera, light, people, settings, power and review.
- Reorder point and safety stock sheet (many parts)Safety stock, reorder point, order quantity and an order list for up to 500 parts, worked out from each part's own demand and lead time history.
- Energy use and EnPI trackerMonthly electricity, gas and fuel in one unit, a 12-month regression baseline, expected against actual energy for each month, an EnPI ratio, the running saving and the tests that say whether the model can be trusted.
- FIFO lane sizing sheetThe maximum for a FIFO lane from the stop it must cover, in whole containers, with length, refill and wait checks for up to eight lanes.
- Pugh matrix templateCompare up to 8 concepts with a datum as better, same or worse on up to 12 criteria, flag must-haves, and carry the strongest into a second round.
- Quad chart templateA project on one page in four boxes: idea and owner, problem, approach, and cost, schedule and result.
- Defect detection matrix templateMap where each defect is created and where it is found, score the gap and move the check closer to the cause.
- Project savings validation checklistThe gate between a project's claim and a reported saving: 20 checks, a claims register and a six-month sustainment check.
- Life cycle cost analysis templateCompare up to three machines over ten years: price, energy, upkeep, failures and down time, discounted to present value.
- Energy loss matrix templateSeven types of energy loss by six energy sources with a cost in each cell, an action plan and an idle-period shutdown checklist.
- Environmental compliance audit checklistAn internal environmental audit: 37 questions with what to look for, a findings log with classes and a score by section.
- APQP checklistThe five APQP phases as a checklist: deliverables, owners, due dates, gate reviews and an issues list.
- Out-of-control action plan (OCAP) templateA reaction plan for a control chart: the steps, what each signal means, who to call and a log of events.
- Quality inspection checklistAn in-process and final inspection record: measured characteristics, visual checks, a decision and first pass yield.
- AQL sampling plan templatePick a sample size, read accept and reject numbers, record the defects and decide on the lot.
- MSA study workbookBias, linearity and stability study sheets for a gauge, with the arithmetic done and a guide to which study when.
- Incoming quality control stage sheetA register that shows how much control each purchased part has and plans the move from your dock to the supplier's process.
- Internal audit schedule templateA year of internal audits planned by risk: the programme, the register, the auditors and the findings.
- Approved supplier list templateThe list of suppliers you may buy from, with the evidence behind each, certificate expiry alerts and re-evaluation dates.
- Pest control inspection checklistA pest control walk-round for a food plant, with a log of traps and stations and action levels for each type of device.
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A shift handover sheet, a red tag log, a changeover checklist for one machine: if your team uses it on the floor, ask.