Title Page

  • Permit Number

  • Contractor

  • Site Location
  • Conducted on

  • Prepared by

General Details

  • Purpose of Entry

  • Communication Procedures

  • Other communication procedures

Rescue Procedures

  • Click + to add rescue procedures

  • Procedure
  • Enter details here


  • Indicate whether the following items are completed and reviewed before entry

  • Lockout/Deenergize/Tagout

  • Line(s) Broken-Capped-Blank

  • Purge-Flush and Vent

  • Ventilation

  • Secure Area (Post and Flag)

  • Breathing Apparatus

  • Resuscitator - Inhalator

  • Standby Safety Personnel

  • Full Body Harness Body with D ring

  • Emergency Escape Retrieval Equipment

  • Lifelines

  • Fire Extinguishers

  • Lighting (Explosive Proof)

  • PPE

  • Respirators (Air Purifying)

  • Hot Work Permit (Buring and Welding)


  • Click + to add names of people involved

  • Person
  • Full Name, Signature and Position of Person Involved (e.g. Sheen Meyer - Entrant)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.