Workplace Confined Space Entry Permit

Location of Confined Space:

[Sub-basement Level 2, Section D, Boiler Room]

[Date]

Permit Validity Period: [08:00 AM to 04:00 PM on 29/11/2050]

Purpose of Entry:

[Inspection and maintenance of steam pipes]

Authorized Entrants:

1. [Name - Job Title]

2. [Name - Job Title]

3. [Name - Job Title]
   

Attendant:

[Your Name], [Your Contact Number]

Emergency Contact:

[Name - Job Title], [Your Contact Number]

Potential Hazards:

1.                          

2. ________________

3. ________________
   

Safety Measures & Equipment:

1.                            

2. _________________

3. _________________

Atmospheric Testing:

• Oxygen Level: [19.5%]

• Flammable Gases: [0 ppm]

• Toxic Gases: [0 ppm]

• Other: [N/A]

Communication Procedures:

[Continuous radio communication with the attendant]

Rescue/Emergency Procedures:

In case of emergency, use the intercom to alert the control room. Evacuate immediately if the alarm sounds. The emergency medical kit is located at the entrance.

Additional Notes:

All entrants have completed confined space training as of [October 2050].

Check for updates on weather conditions that may affect safety.

Approval (Signature):

________________

[Name - Job Title]

[Month Day, Year, Time]

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