🚧 OSHA 29 CFR 1910.146

Confined Space Entry Permit

SLP Alaska Safety Management System

📋 Permit Information

Permit Initiator *

Date *

Entry Type *

Client/Company *

Location *

Phone/Radio

Space ID/Name *

Entry Supervisor *

Space Description

Purpose of Entry *

🌡️ Atmospheric Monitoring

Acceptable ranges: O₂: 19.5-23.5% | LEL: <10% | H₂S: <10 ppm | CO: <25 ppm

Oxygen (O₂)
19.5% - 23.5%

LEL (Combustible)
<10% LEL

Hydrogen Sulfide (H₂S)
<10 ppm

Carbon Monoxide (CO)
<25 ppm

Other Toxic (specify)

Atmospheric Hazard Present?

⚠️ Physical Hazards

Check all hazards present:

Engulfment

Entrapment

Mechanical

Electrical

Thermal

Noise

Fall

Slip/Trip

Chemical

Biological

Radiation

Other

Other Hazard Description

📋 Alternate Entry Eligibility

Alternate Entry may only be used when the ONLY hazard is atmospheric AND can be controlled by continuous ventilation.

Alternate Entry Eligible?

Only hazard is atmospheric?

Ventilation controls the hazard?

Monitoring data supports safe entry?

🛡️ Required Controls & Mitigations

Ventilation & Respiratory

Continuous Air Monitoring

Forced Air Ventilation

Natural Ventilation

Respiratory Protection Required

Respiratory Type

Isolation & Lockout

LOTO Required

LOTO Verified

Line Breaking/Blanking

Retrieval & Fall Protection

Retrieval System

Tripod/Davit

Full Body Harness

Lifeline Attached

Fall Protection

PPE Requirements

Hearing Protection

Eye/Face Protection

Head Protection

Hand Protection

Foot Protection

Protective Clothing

Other Controls

Communication Method

Lighting Provided

GFCI Protected Tools

Hot Work Permit Required

Barriers/Barricades

🚑 Rescue Provisions

Rescue Team Identified *

Rescue Team Type

Rescue Equipment Available

Rescue Response Time

Hospital/Medical Facility

Emergency Contact Number

👷 Personnel

Attendant

Attendant Name *

Attendant Trained?

Entrants

Entrant 1 Name

Time In

Time Out

Entrant 2 Name

Time In

Time Out

Entrant 3 Name

Time In

Time Out

✅ Pre-Entry Verification

Pre-Entry Briefing Conducted

All Hazards Communicated to Entrants

Emergency Procedures Reviewed

Equipment Inspected

Permit Posted at Entry Point

✍️ Authorization

Entry Supervisor Signature *

Attendant Signature *

Permit Start Time *

Permit Expiration Time *