Confined Space Entry Permit Template

A Safe Work Method Statement documents a method. It references the entry permit, but it is not the permit. Part 4.3 of the WHS Regulation 2025 (NSW) requires an entry permit for every confined space entry — whether or not that entry is construction work — and the permit is the instrument that records, for one specific space on one specific shift, that the hazards were identified, the isolations were physically verified, the atmosphere was tested and within limits, ventilation was applied, a standby person was posted and non-entry rescue was rigged before anyone went in. An organisation holding only a SWMS has documented its method and left the permit duty undocumented. This document is that permit, authored for wastewater assets in New South Wales: sewers, maintenance holes, wet wells, pump station chambers and treatment plant structures.

The permit runs thirteen numbered sections a competent person completes in order: permit details and validity; a twelve-line hazard identification checklist for the specific space; isolation and lock-out verification including automatic and remote SCADA starts; staged pre-entry atmospheric testing with acceptable ranges for oxygen, H2S, LEL and carbon monoxide, plus instrument calibration and bump test fields; ventilation and continuous monitoring; personnel, standby person and communication method; rescue verification; PPE and equipment; traffic control where the access point sits in a road reserve; permit authorisation; an entry log; a periodic atmospheric re-test log; and cancellation and close-out. The scope boundary is deliberate and stated on the document itself: one permit, one shift, one described task — cancelled on completion, on any change of conditions, or on any alarm. It is a permit instrument, not a SWMS, not a rescue plan and not a calibration procedure; it references the associated SWMS rather than replacing it. Regulator: SafeWork NSW.

Hazards identified

12 hazards covered, sorted by priority.

Control measures

Hierarchy-of-controls order: elimination → substitution → isolation → engineering → administrative → PPE.

1. 1One permit, one shift, one described task — the permit is completed, signed and issued by a competent person before entry, and cancelled on completion, on any change of conditions, or on any alarm.
2. 2No person enters until the permit is issued: Part 4.3 of the WHS Regulation 2025 (NSW) and AS 2865 require a permit for every confined space entry, whether or not the entry is construction work.
3. 3Identify the hazards for this specific space against a twelve-line checklist before anything else is signed — H2S, oxygen deficiency or enrichment, flammable atmosphere, engulfment or flooding, mechanical plant, live traffic, fall more than 2 m, biological, other trade-waste contaminant, restricted entry and egress, heat, humidity or lighting.
4. 4Verify isolation before testing: upstream flow isolated, diverted or controlled with the network controller or plant operator; pump starts locked out including automatic and remote or SCADA start; mixers, aerators, scrapers, screens and mechanical plant isolated and locked out; stored energy released.
5. 5The permit issuer verifies isolations physically — never assumed from a control room indication — with lock-out tags applied and a personal lock fitted by each entrant, and the network controller or plant operator notified and recorded by name and time.
6. 6Test the atmosphere from the surface, never by entering to test, using a calibrated and bump-tested multi-gas instrument, and record the instrument make, model, serial number, last calibration date and today's bump test result on the permit.
7. 7Test in stages — before ventilation, again after ventilation, and immediately before entry — at the full depth of the space, because H2S is heavier than air and pools at the bottom where the worker is going.
8. 8Hold entry against fixed acceptable ranges: oxygen 19.5% to 23.5%, H2S below the workplace exposure standard (10 ppm TWA / 15 ppm STEL), flammable gas below 5% LEL, carbon monoxide below the exposure standard. Any reading outside range means no entry — ventilate and re-test.
9. 9Never proceed on the basis of odour: at higher concentrations H2S rapidly deadens the sense of smell, so the smell disappearing signals greater danger, not less.
10. 10Apply forced mechanical ventilation before entry and maintain it throughout, with the intake in clean air away from exhausts and the space discharge; the entrant carries continuous personal monitoring with audible alarms set, and on alarm withdraws immediately with no re-entry until re-tested and made safe.
11. 11Post a standby person who remains outside for the whole entry, does not enter and takes on no other duties, with the communication method (voice, radio or rope signal) agreed and recorded, and every entrant logged in and out by name, competency, time in and time out.
12. 12Rig non-entry rescue before the entrant enters — tripod or davit, winch and retrieval line functional, entrant in a full-body harness attached to the line, rescue plan understood by all, supplied-air respiratory protection available for any planned entry rescue, emergency services access route clear, 000 contact available, and first aid and resuscitation capability on site. Never enter to rescue: retrieve from outside.
13. 13Where the access point is in a road reserve, install a traffic guidance scheme to AS 1742.3 before the cover is lifted, establish the work area, buffer and taper, place a traffic controller where required, and keep the entry point, standby position and rescue set-up all inside the protected work area with the open chamber guarded against falls by workers and the public.
14. 14Close out the permit deliberately — all personnel accounted for and out, equipment removed, space secured and the cover replaced, isolations and lock-out removed only after all persons are clear, traffic guidance scheme removed, and any incident, near miss or alarm recorded and reported. Retain the permit with the associated SWMS; where a notifiable incident occurs, preserve the site so far as is reasonably practicable and notify SafeWork NSW immediately.
15. 15Only a competent person issues the permit, and entrants, standby persons and permit issuers record their confined space competency on the permit — together with a current White Card (CPCCWHS1001) where the work is on a construction site, and traffic control competency where a scheme is required.
16. 16Consult workers on WHS matters affecting them per Section 47 of the WHS Act 2011 (NSW), record the consultation, and review this permit form and the associated SWMS whenever the assets, method, personnel or exposure standards change, after any incident, or at minimum every 12 months, consistent with Section 302 of the WHS Regulation 2025 (NSW).

Applicable Codes of Practice

High-Risk Construction Work triggered

Worked example

A pump station wet well in a coastal NSW council needs a level probe cleaned. The crew has a confined space SWMS, a tripod and a bump-tested detector. The leading hand rings the control room, asks for the station to be put in manual, gets a yes, and the crew works off that. The gas test is done from the surface and reads clear at the lip. An hour into the entry, an upstream station discharges on its own schedule, the duty pump receives an automatic start command the control room operator never touched, and the well surges. The entrant is standing on a wet bench in rising sewage with a mixer turning below him. Everything that failed here is a line on this permit that would have been signed or refused: pump starts locked out including automatic and remote or SCADA start, not a verbal request to a control room; isolation verified physically by the permit issuer and not assumed from a control room indication; the network controller notified by name at a recorded time; upstream flow isolated, diverted or controlled; testing at the full depth of the space rather than at the lip; the entrant on a retrieval line with a standby person who has no other duties and a winch already rigged. The crew was not careless and they were not short a SWMS. They were short the one document that forces someone competent to walk the isolation, sign their name against it, and refuse the entry until it is true.

Related legislation

• Work Health and Safety Act 2011 (NSW) — Section 19 primary duty of care, owed to workers and to the public near an open chamber; Section 47 consultation; Sections 35-38 notifiable incidents and site preservation.
• Work Health and Safety Regulation 2025 (NSW) — confined spaces (Part 4.3): the entry permit required for every confined space entry, atmospheric monitoring, ventilation, the standby person and emergency and rescue arrangements established before entry, applying independently of construction status.
• Work Health and Safety Regulation 2025 (NSW) — Section 291 (high risk construction work, including work in or near a confined space) and Section 299 (preparation and content of a SWMS), with review under Section 302, applying to the associated SWMS this permit references.
• Work Health and Safety Regulation 2025 (NSW) — hazardous chemicals (Part 7.1) and the workplace exposure standard for hydrogen sulphide (10 ppm TWA / 15 ppm STEL) that the permit's acceptable range is set against.
• AS 2865 (Confined spaces), AS 1742.3 (Traffic control for works on roads), AS/NZS 1891.1 and AS/NZS 1891.4 (fall arrest — selection and use) and AS/NZS 1715 and AS/NZS 1716 (respiratory protective equipment).

Frequently asked questions