Jenkins Academy of Applied Technology
Entry permit requirements review Permit-Required Confined Spaces · v1.0.0 · October 22, 2026
Course developed by Todd Jerome Jenkins, MS, CSP.
Print / save as PDF Complete this worksheet using the actual workplace and current plan. A blank form or course score is not evidence that the action occurred. Record actual dates and observations. Print or save a completed copy before closing; entries are not automatically stored. Keep private health details out of this worksheet.
Actual employer permit number and program version; this learning worksheet does not issue a permit Space to be entered — 1910.146(f)(1) Purpose/task — (f)(2) Date and authorized duration, no longer than the task — (f)(3) Authorized entrants or accurate roster/tracking reference — (f)(4) Current attendants by name — (f)(5) Current entry supervisor and original authorizing supervisor signature/initials — (f)(6) Actual space hazards — (f)(7) Isolation and hazard elimination/control measures — (f)(8) Acceptable entry conditions for each hazard, with units/limits — (f)(9) Initial and periodic test results, tester name/initials and times; locations and equipment per site procedure — (f)(10) Rescue/emergency services and actual means/numbers for summoning — (f)(11) Entrant-attendant communications and evacuation signals — (f)(12) PPE, monitoring, communications, alarms, retrieval and other required equipment — (f)(13) Other information necessary for this space and task — (f)(14) Additional permits, including hot work if applicable — (f)(15) Evidence that required preparations were completed and supervisor signed before entry; permit accessible to entrants Actual termination/cancellation reason and time, problems noted, safe closure and canceled-permit retention at least one year