OSHA 29 CFR 1910.146

Confined Space Entry Permit

Permit-Required Confined Space Entry

⚠️ WARNING: Do NOT enter until all atmospheric tests pass, hazards are controlled, and this permit is signed by the Entry Supervisor.

📋 Permit Information

District / Base *

Date *

Start Time *

End Time *

Confined Space Name/ID *

Space Type *

Specific Location

Entry Type *

Purpose of Entry *

👥 Personnel

Permit Initiator *

Entry Supervisor *

Attendant *

Atmospheric Tester *

Authorized Entrants *

🌡️ Atmospheric Testing

Monitor Serial Number

Gas

Initial

Continuous

Limits

O₂ (%)

19.5% - 23.5%

LEL (%)

< 10%

H₂S (ppm)

< 10 ppm

CO (ppm)

< 25 ppm

Other Gas (if applicable)

Initial Reading

Continuous Reading

⚠️ Hazard Identification

Check all hazards present:

EngulfmentElectricalMechanicalThermalChemicalRadiationConfiguration

Other Hazards / Details

🛡️ Hazard Controls

Lockout/Tagout Complete? *

Lines Blanked/Disconnected? *

Ventilation Type

Ventilation Adequate? *

Lighting Adequate? *

Communication Method *

Rescue Equipment Ready? *

Rescue Type *

Respiratory Protection *

🦺 Required PPE

Select all required PPE:

🪖 Hard Hat

👓 Safety Glasses

🛡️ Face Shield

🎧 Hearing Protection

🔥 FR Clothing

☣️ Chemical Suit

🪢 Fall Protection

Gloves Type

✍️ Authorization Signatures

Entry Supervisor Signature *

Attendant Signature *

AnthroSafe™ Field Driven Safety