HOMETOOLS

Confined Space + LOTO Permit

Combined OSHA 1910.146 + 1910.147 permit-to-work — LOTO first, atmospheric tests, entry, release

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Confined Space + LOTO — Combined Permit

Single permit for confined-space entries where hazardous energy (mechanical, hydraulic, pneumatic, steam, electrical, chemical) must be isolated before atmospheric testing and entry. OSHA 29 CFR 1910.146 & 1910.147.

0/15 pre-entry items

1Space & Permit Details

Permit #
Date
Valid From
Valid To
Confined Space Name / ID
Location
Space Description (geometry, entry points, known hazards)
Description of Work

2Personnel

Entry Supervisor
Attendant (Hole Watch)
Authorized Entrants
Authorized LOTO Employee (Primary Lock Owner)
Badge / ID

3LOTO — Energy Source Inventory (apply BEFORE entry)

Check each energy source present and record the specific disconnect/valve location.

Stored / Residual Energy Notes
Zero-Energy Verification — §1910.147(d)(6)
Verified By (Authorized Employee)
Verification Method

4Atmospheric Tests (after LOTO, before entry)

Record readings from a calibrated, bump-tested monitor. Test in this order: O₂ → flammables → toxics. Continuous monitoring required during entry unless authorized otherwise.

OxygenLimit: 19.5 – 23.5%
FlammablesLimit: < 10%
Carbon MonoxideLimit: < 35 ppm
Hydrogen SulfideLimit: < 10 ppm
Other
Limit: At or below PEL
Retest Frequency

5Communication & Rescue

Communication Method
Emergency Signal
Rescue Type
Rescue Contact (team or phone)
Response ETA

6Pre-Entry Checklist (LOTO → Atmospheric → Entry)

Each item must be Yes or N/A before entry begins. Items are sequenced so LOTO precedes atmospheric testing.

1.LOTO applied to ALL isolatable energy sources feeding the space (§1910.147)
2.Lines / pipes physically blinded, double-block-and-bleed, or LOTO-isolated
3.Mechanical equipment locked out — agitators, conveyors, fans, pumps
4.Zero-energy verified at the point of entry (try-start + multimeter at zero)
5.Space cleaned / purged of residual hazardous material
6.Continuous mechanical ventilation running prior to atmospheric test
7.Atmospheric monitor calibrated + bump-tested TODAY
8.Atmospheric test results within acceptable limits (recorded below)
9.Communication method established (radio channel, voice, signal rope)
10.Retrieval equipment in place (tripod + winch + full-body harness)
11.Rescue team notified; response time verified
12.PPE selected and donned (hard hat, eye/face, respiratory, gloves, fall arrest)
13.Lighting adequate; intrinsically-safe where flammable atmosphere possible
14.Entrants, attendant, supervisor trained and qualified
15.Entry supervisor has reviewed and signed this permit

7Release Sequence — exit, LOTO removal, return to service

Complete in order. No lock is removed until ALL entrants are accounted for outside the space.

1.All entrants accounted for OUTSIDE the space (head count vs. roster)
2.All tools, materials, and equipment removed from the space
3.Guards, covers, and safety devices reinstalled
4.Each lock/tag removed ONLY by the authorized employee who applied it
5.Affected employees notified that equipment is being re-energized
6.Equipment re-energized and function-tested before returning to service
7.This permit canceled and archived per facility retention policy

8Notes / Special Conditions

9Signatures

Entry Supervisor Signature (typed)
Authorized LOTO Employee Signature
Attendant Signature
Released to Service — Signature
Release Time
Read: Confined SpacesRead: LOTO