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Before allowing workers to work on or near energized electrical equipment, steps should be taken to verify that all of the required safety measures are in place. One way to do this is to require that a permit be issued before the work is done. Here’s a general template for an electrical work permit that you can adapt for your own workplace.
Work Location: Work Order Number:
Reason equipment can’t be deenergized (list details explaining item checked):
Increased hazards
Introduction of new hazards
Infeasible due to equipment design
Infeasible due to operational limitations
Other
Description of work to be performed
Safety considerations (check all that apply):
Work is within restricted approach boundary and there is no work plan.
Work is within prohibited approach boundary; work is hazardous and there is no work plan.
A request to shut down equipment was made.
Shock hazard analysis was conducted.
Shock approach boundaries have been determined.
Engineering incident analysis has been completed and results are known.
Arc flash boundary has been determined.
PPE including tools needed for the job have been determined and are available.
Engineering incident analysis has been completed and the results are known.
Unqualified persons are restricted from the work area.
Necessary safe work practices have been considered and are in place.
Job can be done safely.
Qualified Worker Signature: Date:
Immediate Supervisor Signature: Date:
