Jenkins Academy of Applied Technology
Training certification and role proficiency record 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.
Employee name, employer, assigned role(s), actual space/task and procedure version Training trigger: first assignment, changed duties, new hazard, procedure deviation or knowledge/use gap Actual training date(s) and trainer signatures or initials; these are required certification elements Entrant: hazards/exposure signs/consequences, equipment use, communication, alerting and each exit trigger — actual evidence Attendant: hazards/behavioral effects, accurate tracking, outside station/relief, communication, inside/outside monitoring, evacuation, rescue summons, unauthorized-person response and non-entry rescue duties — actual evidence Supervisor: hazards, permit/tests/procedures/equipment verification, rescue availability, authorization, unauthorized access, handover and termination/cancellation — actual evidence Tester/other role: actual equipment and task proficiency; any additional applicable requirements Safe demonstration method and observed result; do not use an uncontrolled space for practice Knowledge or performance gaps, corrective training, reassessment and restrictions Employer certification of actual completed training; record accessible to employee/representative; online score alone does not establish all proficiency Separate rescue-team training, current first-aid/CPR availability and at-least-12-month rescue practice evidence, if assigned; no universal annual refresher inferred for all roles