Safety & Compliance · Permit & Log

Confined Space Entry Permit Issuance & Atmospheric Testing

This permit must be completed before any personnel enter a confined space. It documents isolation, atmospheric testing results (oxygen, flammability, toxicity), ventilation setup, rescue equipment, and emergency contacts. Meets the requirements of WorkSafeBC Part 9, OSHA 1910.146, and NFPA 350. Each entry requires a newly issued permit valid only for a single shift (maximum 8 hours).

Frequency
Per Entry / Pre-Entry
Department
Health & Safety
Regulation
WorkSafeBC / OSHA / NFPA
Version
1.0
Free download — no sign‑up, no email.Take this permit to your confined space entry point and use it as a pre-entry checklist.
Overview & Purpose

This permit serves as the official authorization document for confined space entry. It ensures that all atmospheric hazards have been identified, measured, and controlled before any worker enters the space. The permit includes a step-by-step atmospheric testing schedule, lockout/tagout verification, personal protective equipment (PPE) requirements, and emergency rescue plan. Once signed by the entry supervisor, it becomes a legal record of due diligence and compliance with jurisdictional safety regulations (WorkSafeBC Part 9, OSHA 1910.146, NFPA 350). The permit expires at the end of the shift or when the space is vacated and re‑sealed.

Hazard Assessment Prerequisites
  • HAZARDOxygen deficiency/enrichment: Ensure O₂ level between 19.5% and 23.5% (NFPA 350). If outside this range, ventilate and re‑test before entry.
  • HAZARDFlammable atmosphere: Lower Explosive Limit (LEL) must be less than 10% of the LEL before entry. If >10%, ventilate until below 5% LEL.
  • HAZARDToxic gases: Hydrogen sulfide (H2S) < 10 ppm, Carbon monoxide (CO) < 35 ppm (OSHA PEL). Additional gases per site-specific hazard assessment.
  • PPERequired PPE: Hard hat, safety glasses, steel-toed boots, hearing protection, full-body harness with D‑ring, and retrieval line. Supplied air respirator or SCBA if atmosphere is IDLH or ventilation is inadequate.
  • PPERescue equipment on site: Tripod, winch, lifeline, and trained attendant must be present before any entry begins. Emergency contact numbers posted at space entrance.

Atmospheric Testing Verification Record

Status (P/F) Test Parameter Acceptable Range / Limit Initial Reading After Ventilation Continuous Monitor Alarm?
[ ] Pass [ ] Fail Oxygen (O₂) 19.5% – 23.5% _______ % _______ % Y / N
[ ] Pass [ ] Fail Lower Explosive Limit (LEL) < 10% LEL (after ventilation < 5%) _______ % LEL _______ % LEL Y / N
[ ] Pass [ ] Fail Hydrogen Sulfide (H₂S) < 10 ppm (OSHA PEL) _______ ppm _______ ppm Y / N
[ ] Pass [ ] Fail Carbon Monoxide (CO) < 35 ppm (OSHA PEL) _______ ppm _______ ppm Y / N
[ ] Pass [ ] Fail Other toxic / combustible gases (e.g. VOCs, NH₃) List threshold: _________ _______ ppm _______ ppm Y / N

Note: All gas monitors must be bump‑tested and calibrated per manufacturer specifications prior to use. Record calibration date: ______________

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Incident / Corrective Action Log

Date / Time Item # Safety Issue Identified Corrective Action Taken Assigned To
___/___/_____ _______ _______________________________ _______________________________ _______
___/___/_____ _______ _______________________________ _______________________________ _______
___/___/_____ _______ _______________________________ _______________________________ _______

Use this log to document any atmospheric alarm, equipment failure, or hazard discovered during entry. All corrective actions must be verified by the entry supervisor before work resumes.

Supervisor Sign-Off & Verification

By signing below, the entry supervisor (competent person) certifies that all atmospheric tests have been conducted and are within acceptable limits, isolation and lockout/tagout are complete, rescue equipment is in place, and all entrants have been briefed on the hazards. This permit is valid for one shift only.

Supervisor Name / Signature
Date & Time
Permit Expiry Time (max 8 h from start)
Emergency Contact (phone)

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