Confined Space Entry Checklist

Pre-Entry Planning & Authorization

1 of 8

Verifies necessary permits, hazard assessments, and team qualifications are in place before entry.

Permit Issue Date

Permit Issue Time

Permit Validated By (Supervisor)

Supervisor A

Supervisor B

Supervisor C

Confined Space Designation

Non-Permit Confined Space

Permit-Required Confined Space

Brief Description of Entry Task

Maximum Authorized Entrants

Entry Team Roles Assigned

Attendant

Entrant

Supervisor

Safety Observer

Hazard Assessment Document

Permit Number

Confined Space Identification & Evaluation

2 of 8

Details the specific confined space being entered and initial hazard assessment findings.

Confined Space Name/Location

Brief Description of Confined Space

Dimensions (Length x Width x Height)

Purpose of the Confined Space (e.g., Tank Cleaning, Maintenance)

Potential Hazards Identified (Check all that apply)

Oxygen Deficiency

Toxic Gases

Flammable Atmospheres

Engulfment Hazard

Physical Hazards (e.g., Noise, Heat)

Other (Specify in Long Text)

Specific Hazards and their Potential Severity

Confined Space Classification (Based on initial assessment)

Non-Permit Space

Permit-Required Space

Date of Assessment

Hazard Identification & Control

3 of 8

Lists identified hazards and the controls implemented to mitigate them (e.g., ventilation, lockout/tagout).

Describe Potential Hazards Identified (e.g., Oxygen Deficiency, Toxic Gases, Engulfment)

Potential Hazards Present (Select all that apply)

Oxygen Deficiency

Toxic Gases (Specify: ________)

Flammable/Explosive Atmospheres

Engulfment Hazard

Physical Hazards (e.g., Noise, Heat, Cold)

Other (Specify: ________)

Describe Control Measures Implemented for Each Hazard (e.g., Ventilation, Lockout/Tagout, Isolation)

Ventilation Rate (CFM)

Lockout/Tagout Procedures Verified?

Energy Source Identified

Isolation Devices Verified

Lock/Tag Applied

Equipment De-energized

Specific Procedures for Hazard Mitigation (e.g., gas blanketing)

Residual Risk Level (After Controls)

Low

Moderate

High

Unacceptable - Entry Prohibited

Date of Hazard Control Verification

Time of Hazard Control Verification

Atmospheric Monitoring & Ventilation

4 of 8

Documents atmospheric testing results and ongoing ventilation procedures.

Atmospheric Monitoring Start Time

Oxygen (O₂) Reading (ppm/%)

Flammable Gas/Vapor Reading (LEL%)

Hydrogen Sulfide (H₂S) Reading (ppm)

Ventilation Status

Mechanical Ventilation

Forced Air Ventilation

Natural Ventilation

No Ventilation Required

Ventilation System Description (Fan type, CFM, etc.)

Last Atmospheric Monitoring Time

Monitoring Equipment Calibration Status

Calibrated and Within Date

Calibration Due

Out of Calibration

Entry Permit & Team Briefing

5 of 8

Confirms the permit is valid, and the entry team has been briefed on roles, responsibilities, and procedures.

Permit Issue Date

Permit Issue Time

Permit Expiration Date

Permit Expiration Time

Permit Authorizing Supervisor

Supervisor A

Supervisor B

Supervisor C

Permit Number

Briefing Summary (Team Discussion Points)

Team Roles Confirmed?

Attendant

Entrant

Supervisor

Alternate Entrant

Communication Method Confirmed?

Verbal

Radio

Hand Signals

Entrant Acknowledgement

Equipment & Safety Gear

6 of 8

Verifies proper safety equipment is available and in good working order (e.g., harnesses, lifelines, respirators).

Harness Inspection Status

Pass

Fail - Repair Needed

N/A - Not Required

Lifeline Inspection Status

Pass

Fail - Repair Needed

N/A - Not Required

Respirator Fit Test Expiration Date (MM/DD/YYYY)

Respirator Type

SCBA

APR

None Required

Lighting Equipment

Present & Functioning

Missing/Defective

PPE Check

Hard Hat

Safety Glasses

Gloves

Steel-toed boots

Hearing Protection

Communication Device

Functional Radio

Functional Alternate Communication

Not Required

Entry & Ongoing Monitoring

7 of 8

Records observations during entry, including continuous atmospheric monitoring results and team communication.

Entry Start Time

Oxygen Level (%)

Flammable Gas/Vapor Level (%)

Lower Explosive Limit (LEL) (%)

Atmospheric Monitoring Status

Continuous

Intermittent

Observer Notes/Communication Log (Record all communications and significant observations)

Last Atmospheric Monitoring Time

Unusual Occurrence?

Yes

Description of Unusual Occurrence (if Yes)

Exit & Post-Entry Procedures

8 of 8

Details the steps taken during exit and any post-entry tasks required (e.g., equipment inspection, permit closure).

Exit Time

Post-Entry Observations (Unusual Events, Issues)

Atmospheric Readings Upon Exit (O2, LEL, H2S, etc.)

Equipment Condition After Use (Satisfactory/Needs Repair)

Satisfactory

Needs Repair

Equipment Requiring Repair (Check all that apply)

Harness

Lifeline

Respirator

Ventilation Fan

Lighting

Communication System

None

Pre-Entry Planning & Authorization

Permit Issue Date

Permit Issue Time

Permit Validated By (Supervisor)

Confined Space Designation

Brief Description of Entry Task

Maximum Authorized Entrants

Entry Team Roles Assigned

Hazard Assessment Document

Permit Number

Confined Space Identification & Evaluation

Confined Space Name/Location

Brief Description of Confined Space

Dimensions (Length x Width x Height)

Purpose of the Confined Space (e.g., Tank Cleaning, Maintenance)

Potential Hazards Identified (Check all that apply)

Specific Hazards and their Potential Severity

Confined Space Classification (Based on initial assessment)

Date of Assessment

Hazard Identification & Control

Describe Potential Hazards Identified (e.g., Oxygen Deficiency, Toxic Gases, Engulfment)

Potential Hazards Present (Select all that apply)

Describe Control Measures Implemented for Each Hazard (e.g., Ventilation, Lockout/Tagout, Isolation)

Ventilation Rate (CFM)

Lockout/Tagout Procedures Verified?

Specific Procedures for Hazard Mitigation (e.g., gas blanketing)

Residual Risk Level (After Controls)

Date of Hazard Control Verification

Time of Hazard Control Verification

Atmospheric Monitoring & Ventilation

Atmospheric Monitoring Start Time

Oxygen (O₂) Reading (ppm/%)

Flammable Gas/Vapor Reading (LEL%)

Hydrogen Sulfide (H₂S) Reading (ppm)

Ventilation Status

Ventilation System Description (Fan type, CFM, etc.)

Last Atmospheric Monitoring Time

Monitoring Equipment Calibration Status

Entry Permit & Team Briefing

Permit Issue Date

Permit Issue Time

Permit Expiration Date

Permit Expiration Time

Permit Authorizing Supervisor

Permit Number

Briefing Summary (Team Discussion Points)

Team Roles Confirmed?

Communication Method Confirmed?

Entrant Acknowledgement

Equipment & Safety Gear

Harness Inspection Status

Lifeline Inspection Status

Respirator Fit Test Expiration Date (MM/DD/YYYY)

Respirator Type

Lighting Equipment

PPE Check

Communication Device

Entry & Ongoing Monitoring

Entry Start Time

Oxygen Level (%)

Flammable Gas/Vapor Level (%)

Lower Explosive Limit (LEL) (%)

Atmospheric Monitoring Status

Observer Notes/Communication Log (Record all communications and significant observations)

Last Atmospheric Monitoring Time

Unusual Occurrence?

Description of Unusual Occurrence (if Yes)

Exit & Post-Entry Procedures

Exit Time

Post-Entry Observations (Unusual Events, Issues)

Atmospheric Readings Upon Exit (O2, LEL, H2S, etc.)

Equipment Condition After Use (Satisfactory/Needs Repair)

Equipment Requiring Repair (Check all that apply)

Permit Expiration Date (Confirmation)

Permit Issuer Signature (Confirmation)

Corrective Actions Required (if applicable)

Manufacturing Management Solution Screen Recording

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Manufacturing Inventory Control Checklist Template