Title Page

  • Confined Space ID or #

  • Client / Site

  • Location
  • Conducted on

  • Prepared by

General Information

  • Type of Confined Space

  • other confined space type

  • Take a photo of the confined space

  • How often is this space entered?

  • Work to be performed

  • Equipment to be worked on

  • Name of Entry Supervisor

  • Name of the Entrant/s

  • Name of the Attendant/s

  • Classification of Confined Space

Area, Atmosphere Testing & Ventilation

  • Is the space posted with a sign stating “Danger – Follow Confined Space Entry procedure”?

  • REFERENCE: A sign required to be posted in the entrance of the confined space
    [This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

  • Are confined spaces thoroughly emptied of any corrosive, hazardous or decaying substance that may produce a hazardous atmosphere?

  • Was atmospheric hazard testing done in the proper order? (oxygen, then combustible gases and vapors and then toxic gases and vapors)?

  • Is the ventilation adequate?

  • Is the ventilator safe and grounded?

  • Was atmospheric hazard testing repeated after ventilation?

  • Is there an entrance barricade installed?


  • Has each employee been trained and demonstrated a proficiency in the understanding, knowledge, and skills necessary for the safe performance of duties relating to the confined space?

  • Have the entrants been trained in the hazards of the entry, the signs of exposure, to properly use the equipment and communicate with the attendant?

  • Have the attendants been trained in the hazards of the entry, to recognize behavioral effects of hazard exposure in authorized entrants and to call for rescue services if necessary?

  • Has the employer evaluated the rescuers or emergency service’s ability to respond in a timely manner?

Equipment and PPE

  • Is the entrant wearing proper PPE?

  • Are fall protection gears (harness and lifelines) used?

  • Is self-contained breathing apparatus available if needed?

  • Are the tools to be used explosion proof?

  • Has necessary lighting equipment been provided?

  • Is there a continuous gas monitoring device in place?


  • Are all the employees involved in the entry listed on the permit?

  • Has the entry supervisor signed off on the permit indicating that entry conditions are acceptable?

  • Are completed entry permits posted near the confined space entrance for all involved to observe?

  • Are the permits saved for one year for review?


  • Write recommendations here


  • Full Name and Signature of the Inspector

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.