Confined Space Entry Permit

All contractors, tenants and ADG staff must complete this Permit and have it approved before commencing any confined space entry work. The purpose of this Permit is to ensure that all safety aspects of confined space entry work have been considered and actioned.

Note: registration is necessary before any work on ADG Leased Area is permitted.

*Please register your business with ADG before proceeding. Please click here to register. 

*Please complete the Working on Airport induction before proceeding with the application. 

Part 1 – Application Details
Person in Charge of Works
Applicant's email address

ADG Point of Contact/ Project Manager Details

Part 2 – Description of Works

*End date of works should be after the start date of works.

Part 3 – Isolation
Does the space need to be isolated from:
Note: The Conditions of Isolation from points of supply must remain unchanged during the currency of this Permit.
Part 4 - Atmosphere

The atmosphere in the confined space has been tested and the results are as follows:

Note: LEL = Lower Explosive Limit, CSE = Confined Space Entry

in %
in ppm
in ppm
in ppm
in % LEL
in % LEL
Will entry be made:

*If safe levels are exceeded, no entry is allowed. Contact the Health & Safety Manager.

Part 5 – Hot Work
Part 6 – Personal Protective Equipment and Safety Precautions
Part 7 – Acknowledgement of Applicant

I confirm that:

  • I will comply with the ADG special conditions decided by the ADG authorised person.

  • I agree to repair any damage caused to the site or pay the costs associated with any repair work.

  • I agree to comply with all work health and safety requirements as outlined in our SWMS.

  • I will return my copy of this Permit for cancellation by the ADG Authorised Person, once work has been safely completed.

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Part 8 – ADG Special Conditions
Part 9 – Authorisation to Work
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Part 10 – Cancellation of Permit from the Applicant
Responsible Person
For providing As-built or amendments drawings
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Part 11 - Cancellation of Permit from ADG
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*Please fix the date above