Confined space entry permit
Space ID 1Utility
- Name
- Northgate Fabrication
- avery@example.com
- Phone
- 555-0110
- Address
- 120 Foundry Rd, Springfield
Facility
- Name
- Avery Lund
- Address
- 120 Foundry Rd, Springfield
- Location
- 44.05, -123.09
Permit space
- Space ID
- Space ID 1
- Type
- Manhole
- Classification
- Permit-required
- Location at the facility
- North bay
and 1 more fields
Entry permit
- Date
- Sep 11, 2026
- Authorized from
- Sep 11, 2026
- Authorized until
- Apr 19, 2027
- Purpose of the entry
- Recorded on site.
and 20 more fields
Pre entry
| Danger sign or barrier at the opening | Pass |
| Isolation on the permit done: lockout, blanks, lines broken | Pass |
| Ventilation running, drawing clean air | Pass |
| Traffic and pedestrian barriers up | Pass |
| Harness and retrieval line on each entrant, tripod and winch set | Pass |
| Rescue service reached and the way to call them tested | Pass |
and 3 more on the full report
Readings
| Oxygen, pre-entry | Not taken | Recorded |
| Oxygen, pre-entry range | 19.5 to 23.5 percent | Pass |
| Flammable gas, pre-entry, percent of LFL (LEL on most meters) | 6 % LFL | Pass |
| Hydrogen sulfide, pre-entry | Not taken | Recorded |
| Carbon monoxide, pre-entry | Not taken | Recorded |
Air test during entry
| Time tested | Tester | Test | Oxygen | Flammable gas | Hydrogen sulfide |
|---|---|---|---|---|---|
| Sep 11, 2026 | Tester 1 | Periodic | 1 % | 1 % LFL | 1 ppm |
| Aug 24, 2026 | Tester 7 | Periodic | 43 % | 5 % LFL | 5 ppm |
Close out
| Every entrant out and counted | Pass |
| Equipment out and the opening closed | Pass |
| Permit cancelled, problems written on it | Pass |
Signature
Not signed in the app; signed on paper if at all.