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Energized Work Permit Guide

This document is an energized work permit with the following sections: 1. Part 1 is completed by the requester providing details of the circuit/equipment, description of work, and justification for why the work cannot be deferred. 2. Part 2 is completed by the electrically authorized person doing the work providing details of safe work practices, shock and arc flash risk assessments, necessary PPE, means to restrict access, and confirmation that the work can be done safely. 3. Part 3 requires approval signatures from an electrical safety coordinator, assistant, and manager to perform the work while energized.

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275 views1 page

Energized Work Permit Guide

This document is an energized work permit with the following sections: 1. Part 1 is completed by the requester providing details of the circuit/equipment, description of work, and justification for why the work cannot be deferred. 2. Part 2 is completed by the electrically authorized person doing the work providing details of safe work practices, shock and arc flash risk assessments, necessary PPE, means to restrict access, and confirmation that the work can be done safely. 3. Part 3 requires approval signatures from an electrical safety coordinator, assistant, and manager to perform the work while energized.

Uploaded by

halex
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ENERGIZED WORK PERMIT

Requester: Date: / / Branch:

PART 1: TO BE COMPLETED BY THE REQUESTER

Date Start: / / Date End: / /

1.) Description of circuit/equipment and job location:

2.) Provide description of work to be done:

3.) Justification for why the circuit/equipment cannot be denergized or the work deferred until the next
scheduled outage:

PART 2: TO BE COMPLETED BY THE ELECTRICALLY AUTHORIZED PERSON DOING THE WORK


Check when complete
1.) Detailed job description procedure to be used in performing the above work:

2.) Description of safe work practices employed:

3.)Results of the shock risk assesment:


a.) Limited approach boundary:
b.) Restricted approach boundary:
c.) Necessary shock personal and other protective equipment to safely perform the assigned task:

4.) Results of the arc flash risk assesment


a.) Available incident energy at the working distance or arc flash PPE category:
b) Arc flash boundary:
c.) Necessary arc flash personal & other protective equipment to safely perform the assigned task:

Arc rated coveralls 11 cal Balaclava / hood 10cal Arc rated flash suit 40 cal other:

Arc rated shirt/pants 8 cal Safety glasses Arc surpression blanket other:

HRC gloves (class 2 or 0) Class Hearing protection Insulated tools other:

E Hardhat & Face Shield Approved foot wear Insulating blanket other:

5.)Means employed to restrict access of unqualified persons to the work area:

6.)Evidence of completion of a job briefing, including discussion of any job related hazards

7.)Do you agree that the above detailed work can be done safely? Yes or No (if no return to requester)

Electrically authorized person(s) Date:

Electrically authorized person(s) Date:

PART 3: APPROVAL(S) TO PERFORM THE WORK WHILE ELECTRICALLY ENERGIZED

Electrical Safety Cordinator: Date:

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