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Energized Electrical Work Permit

This document is an energized electrical work permit that outlines safety requirements for working with energized electrical equipment. It requires specifying the location and tasks, determining protection boundaries, and selecting proper PPE. It also mandates restricting the work area, following safe work practices, having emergency equipment, and obtaining approval signatures only after a job safety briefing confirms the work can be done safely.

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Cory Gaye
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© Attribution Non-Commercial (BY-NC)
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420 views1 page

Energized Electrical Work Permit

This document is an energized electrical work permit that outlines safety requirements for working with energized electrical equipment. It requires specifying the location and tasks, determining protection boundaries, and selecting proper PPE. It also mandates restricting the work area, following safe work practices, having emergency equipment, and obtaining approval signatures only after a job safety briefing confirms the work can be done safely.

Uploaded by

Cory Gaye
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Energized Electrical Work Permit

for Activities with Hazard/Risk Category 1, 2, or 3


PART 1: To be completed by Requester: Where in the facility will task(s) be performed __________________________________________________ Describe task(s) to be performed:

PART 2: To be completed by Qualified Person: Flash Protection Boundary Distance __ feet, __ inches. (from one-line drawing or equipment label) - Limited Approach Boundary 3 feet, 6 inches - Restricted Approach Boundary Distance 1 feet, 0 inches - Prohibited Approach Boundary 1 inch

Required PPE:

Untreated cotton underwear Safety glasses or goggles Leather shoes

FR long-sleeved shirt & pants, or coveralls Hardhat with arcrated face shield Hearing protection

Voltage rated electrical gloves Leather gloves

Check Means of Restricting Area:


Locked room Warning sign(s) Cones & caution tape or equivalent barrier Attendant

Check Safe Work Practices & Emergency Procedures:


Voltage-rated tools Fire extinguisher Install barrier between energized circuits Nearby telephone, cellphone, or radio

Check volt meter Emergency phone number ________________

Other:_____________________________________________________________________________________________________ _ PART 3: Approval Signatures: Job Safety Briefing has been conducted and work can be performed safely. Qualified Person/Title Approved by: Electrical Safety Coordinator Production Manager Date Date Date

Electrical Safety Program

rev. 10/19/07

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