# Form - Confined Space Entry Permit

> Fire Service Safety Management System, version 0.3.3 (2026-10-25). The Human Factor. Document FSSMS-FRM-40.
>
> Canonical: https://thehumanfactor.ca/library/fire-service-safety/form-confined-space-entry-permit
>
> Licence: CC BY-NC-SA 4.0 with the Adopting Agency Grant (https://creativecommons.org/licenses/by-nc-sa/4.0/)
>
> General information only, not legal, medical or other professional advice. Verify every requirement against the current official text of the law, standards and manufacturer instructions that apply to you. Obtain your own legal review and consult your joint health and safety committee before adopting anything. You adopt, adapt, implement and rely on this material entirely at your own risk and on your own responsibility. Full terms: Terms of Use, thehumanfactor.ca.

One permit for every planned entry by a member: training entries into props and real spaces, maintenance, inspection and contracted standby ([Policy - Confined Space](https://thehumanfactor.ca/library/fire-service-safety/policy-confined-space) clause 5.3). At an emergency rescue the attendant’s entry log and the incident record take its place ([Confined Space Program](https://thehumanfactor.ca/library/fire-service-safety/confined-space-program) section 17.2). The competent person completes Parts A to G and certifies Part I; the supervisor in charge authorizes entry; the permit is posted at the entrance for the whole entry, closed in Part J, and filed in {{Records system}}. The content follows the entry rules of the applicable confined space regulation ([J17 Confined Space](https://thehumanfactor.ca/library/fire-service-safety/j17-confined-space)) and the confined space management standard (CSA Z1006:23); the sampling practice follows the fire service air monitoring guidance (MLITSD, n.d., GN 6-51).

> **Warning: Stop rule**
>
> Any alarm, any loss of communication or any change in the space: everyone out. The permit is suspended until the competent person retests and signs again in Part I.

## The form

| Part and field | Entry |
|:---|:---|
| **A. Space and entry** |  |
| Permit number; space ID from the inventory; location |  |
| Space description; purpose (training / maintenance / inspection / contracted standby, with agreement reference / other) |  |
| Work to be done; number of entrants |  |
| Date; valid from (time) to (time), no longer than the maximum the applicable regulation sets ([J17 Confined Space](https://thehumanfactor.ca/library/fire-service-safety/j17-confined-space)) |  |
| **B. Hazard assessment** (recorded as the space is, without the protection of PPE or ventilation) |  |
| Atmospheric: oxygen deficiency, oxygen enrichment, flammable gas or vapour, toxic contaminants (name each) |  |
| Engulfment; configuration (sloping floor, converging walls, entrapment); mechanical and electrical energy |  |
| Temperature; biological; noise; fall into a vertical opening (depth) |  |
| Access and egress: opening size allows passage with PPE and rescue equipment (yes / no) |  |
| Assessed by (competent person name), date and time |  |
| **C. Isolation and lockout** |  |
| Each energy source and each line that could admit a product: isolation method (blank, blind, disconnect, double block and bleed), lock number, verified by test (by, time) |  |
| Lockout record attached (yes / no) |  |
| **D. Purging and ventilation** |  |
| Purged (number of times, method) and retested |  |
| Continuous ventilation (yes / no); fan ID; intake clear of contaminants; explosion-proof where flammables are possible |  |
| **E. Atmospheric testing** |  |
| Instrument ID and sensors fitted; bump test (time, result, by); last calibration date, within the manufacturer’s interval |  |
| Pump and tubing delay allowed (seconds) |  |
| Pre-entry readings, one line per level (time; top, middle or bottom; oxygen percent; LEL percent; carbon monoxide ppm; hydrogen sulphide ppm; other; tester initials) |  |
| Entry criteria met: oxygen within the range the applicable regulation sets; flammable gas below 10 percent of the LEL (department action level); each contaminant below its exposure limit (yes / no) |  |
| Continuous monitoring set; alarm set points recorded |  |
| **F. Controls and equipment** |  |
| Respiratory protection (none required by the readings / air-purifying only where the atmosphere is known, stable and within its limits / SCBA / supplied air with escape cylinder) |  |
| Harness and retrieval line on each entrant (yes / not practicable, with reason); retrieval device ID and last inspection |  |
| Communication, primary and back-up; evacuation signal |  |
| Lighting and tools (battery / double-insulated / low-voltage / intrinsically safe); signs and barricades; charged hoseline where flammables are possible |  |
| **G. Rescue plan** |  |
| Method (non-entry retrieval / entry rescue by the department team / designated rescue service, with agreement reference) |  |
| Rescue team location and time to rescue-ready; equipment rigged and checked (time) |  |
| Medical support and how the attendant calls the rescue |  |
| **H. People** |  |
| Supervisor in charge; competent person |  |
| Attendant (name, training date) |  |
| Each entrant (name, entrant training date, fit test current for the respirator worn, respirator clearance current yes / no) |  |
| **I. Certification and authorization** |  |
| Competent person certifies the conditions (signature, time); re-certification after any suspension (signature, time) |  |
| Supervisor authorizes entry (signature, time); permit posted at the entrance (time) |  |
| **J. Closure** |  |
| All entrants out and counted (time); entry log reference |  |
| Alarms, evacuations or suspensions (time, reason) |  |
| Lockout removed (by, time); permit cancelled (by, time) |  |
| Near misses or incidents reported (reference); after-action review held (date, tier) |  |
| Filed (by, date) |  |

## Fields

| Field | Type | Required | Who completes |
|:---|:---|:---|:---|
| Permit number; space ID; location | Text, unique number | Yes | Competent person |
| Description, purpose, work, entrant count | Text; single choice; number | Yes | Competent person |
| Validity period | Date and times | Yes | Competent person |
| Hazard assessment items | Choice per hazard with notes | Yes | Competent person |
| Isolation lines | Text, lock numbers, verification time | Yes where any energy source or line exists | Competent person with the isolating member |
| Purging and ventilation | Number; text; yes / no | Yes | Competent person |
| Instrument, bump, calibration, delay | Text; time; date; seconds | Yes | Atmospheric tester |
| Pre-entry readings at three levels | Numbers and times | Yes | Atmospheric tester |
| Entry criteria met | Yes / no | Yes; entry stops at any no | Competent person |
| Controls and equipment | Choices with notes | Yes | Competent person |
| Rescue plan | Choice; text; time | Yes | Supervisor in charge |
| People and training dates | Text and dates | Yes | Supervisor in charge |
| Certification and authorization | Signatures and times | Yes | Competent person; supervisor in charge |
| Closure items | Times, text, references | Yes | Attendant and supervisor in charge |

**Retention.** At least the period the applicable regulation sets ([J17 Confined Space](https://thehumanfactor.ca/library/fire-service-safety/j17-confined-space)), and longer for any entry with an alarm, an evacuation or an incident, which is kept with the incident record ([Confined Space Program](https://thehumanfactor.ca/library/fire-service-safety/confined-space-program) section 9). **Privacy.** The permit records whether an entrant’s respirator clearance is current, never the medical details.

## Jurisdiction requirements

This chapter relies on the following legal requirements, which differ by province and territory. Check your jurisdiction’s section on each topic page before adopting it.

| Topic | What to check in your jurisdiction | Page |
|:---|:---|:---|
| Confined Space | The permit or certificate content, its maximum validity, posting and retention; the atmospheric entry limits (oxygen range, percent of LEL, contaminants) and when supplied air is required; attendant, retrieval and rescue rules; whether the rules apply in full to contracted standby rescue; and any firefighter rescue exemption and its conditions (a planned entry, including training, always needs this permit) | [J17 Confined Space](https://thehumanfactor.ca/library/fire-service-safety/j17-confined-space) |

## References

CSA Group. (2023). *CSA Z1006:23, Management of work in confined spaces* (3rd ed.). <https://www.csagroup.org/store/product/CSA_Z1006:23/>

Ontario Ministry of Labour, Immigration, Training and Skills Development \[MLITSD\]. (n.d.). *Firefighter guidance notes* (Section 21 Advisory Committee; individual notes revised to 2026). <https://www.ontario.ca/document/firefighter-guidance-notes>