Confined Space Non-Permit Certificate
This non-permit certificate may be used for confined spaces that pose no actual or potential atmospheric
hazard above acceptable safe levels and if all non-atmospheric hazards can be eliminated without entry
into the space. If the space must be entered to eliminate non-atmospheric hazards, the initial entry must
be done in full compliance with the requirements of the confined space entry permit. If an atmospheric or
non-atmospheric hazard is observed, personnel must exit the space immediately and the space must be
reevaluated.
Date/Time:
Certification Expires Date/Time:
Space Location and Description:
Purpose of Entry:
CERTICIATE REQUIREMENTS
 Actual or potential atmospheric hazard above acceptable safe levels do not exist in this space
 Non-Atmospheric hazards do not exist in this space or have been eliminated without entry
 Entrants are informed to exit the space if any hazard is observed
ATMOSPHERIC TESTING REQUIRED (Prior to Entry)
Oxygen
19.5% to 23.5%
Time
Reading
CO2
< 5000 PPM or
.50%
Reading
LEL
< 10%
CO
< 25 PPM
H2S
< 5 PPM
Reading
Reading
Reading
Other
Reading
Tests performed by:
CERTIFICATION
I hereby certify that based on the foregoing test results, the confined space described in this certification is classified as a non-permit space:

Non-Permit Confined Space: The foregoing results indicate that all permit-regulated atmospheric
hazards have been permanently removed.
Entry Supervisor
Date