QA/QC  › HSE Permits & Safety  › Confined Space Entry
Form · QC-HSE-PRM-003
Confined Space Entry Permit
20 checkpoints across 7 sections. Before any entry into tanks, manholes, sumps, pits, silos or other confined spaces
20 Checkpoints
7 Sections
Per shift or per entry activity
HSE Officer, Permit Issuer

Checklist Preview

S.No.CheckpointIS RequirementStatus
A. PRE-ENTRY ISOLATION
A1All inlet/outlet lines physically isolated by blanks, spades, or double-block-and-bleed
Acceptance: Positive isolation verified; blind list signed; P&ID marked; no valve-only isolation
Cl. 7 — Isolation
OK
NC
NA
HOLD
A2Electrical and mechanical equipment inside space locked out and tagged out (LOTO)
Acceptance: LOTO lock by entrant; try-out tested at local isolator; tag signed and dated
Cl. 7 — Energy isolation
OK
NC
NA
HOLD
A3Space drained, purged, and cleaned of previous contents; residues removed
Acceptance: Drain fully; steam/water/N2 purge done; sludge removed; visual check done
Cl. 7 — Cleaning
OK
NC
NA
HOLD
B. ATMOSPHERIC TESTING
B1Oxygen level tested: 19.5% to 23.5%; measured at top, middle, and bottom of space
Acceptance: O2 = 19.5-23.5% at all levels; calibrated gas meter used; readings logged
Cl. 7 — O2 level
OK
NC
NA
HOLD
B2Flammable gas / LEL tested: <10% LEL before entry and during work
Acceptance: LEL <10%; continuous monitoring where gas may accumulate; alarm set 10%
Cl. 7 — Flammability
OK
NC
NA
HOLD
B3Toxic gases tested (H2S <10 ppm, CO <25 ppm, and others per previous contents)
Acceptance: H2S <10 ppm; CO <25 ppm; ammonia <25 ppm; other toxics below PEL
Cl. 7 — Toxicity
OK
NC
NA
HOLD
B4Continuous gas monitor taken inside by entrant; alarm settings verified
Acceptance: Personal 4-gas monitor on entrant; alarms active; calibration certificate current
Cl. 7 — Continuous monitoring
OK
NC
NA
HOLD
C. VENTILATION
C1Mechanical ventilation (forced air) provided; minimum 20 air changes per hour
Acceptance: Blower running; duct reaches bottom of space; fresh air intake clean
Cl. 7 — Ventilation rate
OK
NC
NA
HOLD
C2Exhaust positioned to remove heavy / light gases as per gas characteristics
Acceptance: H2S/LPG: exhaust low; ammonia/methane: exhaust high; cross-ventilation achieved
Cl. 7 — Air flow pattern
OK
NC
NA
HOLD
Showing 9 of 20 checkpoints ·
A. PRE-ENTRY ISOLATION
A1All inlet/outlet lines physically isolated by blanks, spades, or double-block-and-bleed
Cl. 7 — Isolation (IS 14489)
Positive isolation verified; blind list signed; P&ID marked; no valve-only isolation
OKNCNAHOLD
A2Electrical and mechanical equipment inside space locked out and tagged out (LOTO)
Cl. 7 — Energy isolation (IS 14489)
LOTO lock by entrant; try-out tested at local isolator; tag signed and dated
OKNCNAHOLD
A3Space drained, purged, and cleaned of previous contents; residues removed
Cl. 7 — Cleaning (IS 14489)
Drain fully; steam/water/N2 purge done; sludge removed; visual check done
OKNCNAHOLD
B. ATMOSPHERIC TESTING
B1Oxygen level tested: 19.5% to 23.5%; measured at top, middle, and bottom of space
Cl. 7 — O2 level (IS 14489)
O2 = 19.5-23.5% at all levels; calibrated gas meter used; readings logged
OKNCNAHOLD
B2Flammable gas / LEL tested: <10% LEL before entry and during work
Cl. 7 — Flammability (IS 14489)
LEL <10%; continuous monitoring where gas may accumulate; alarm set 10%
OKNCNAHOLD
B3Toxic gases tested (H2S <10 ppm, CO <25 ppm, and others per previous contents)
Cl. 7 — Toxicity (IS 14489)
H2S <10 ppm; CO <25 ppm; ammonia <25 ppm; other toxics below PEL
OKNCNAHOLD
B4Continuous gas monitor taken inside by entrant; alarm settings verified
Cl. 7 — Continuous monitoring (IS 14489)
Personal 4-gas monitor on entrant; alarms active; calibration certificate current
OKNCNAHOLD
C. VENTILATION
C1Mechanical ventilation (forced air) provided; minimum 20 air changes per hour
Cl. 7 — Ventilation rate (IS 14489)
Blower running; duct reaches bottom of space; fresh air intake clean
OKNCNAHOLD
C2Exhaust positioned to remove heavy / light gases as per gas characteristics
Cl. 7 — Air flow pattern (IS 14489)
H2S/LPG: exhaust low; ammonia/methane: exhaust high; cross-ventilation achieved
OKNCNAHOLD
Showing 9 of 20 ·
Inspection Sign-Off
APPROVED
APPROVED WITH CONDITIONS
REJECTED — NCR RAISED
Remarks
Name / Sign / Date
Inspected By
Name / Sign / Date
Reviewed By
Name / Sign / Date