• Energized Electrical Work Permit

    Energized Electrical Work Permit

  • Date*
     - -
  • Is this a Subcontractor or IWS employee/affiliate filling out the form
  • Is this a printed permit

  • Under NFPA 70E, there are only two instances in which an employee can work on live parts. In these situations, a work permit must be completed and approved by an authorized person.

    1. When de-energizing would interrupt essential life support, emergency alarms or ventilation systems.
    2. When the organization can demonstrate that de-energizing the system would introduce additional or increased hazards or that it is infeasible due to equipment design or operational limitations.
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  • Details

    What are you planning to do?

  • Justification

    Why is this work being performed without first de-energizing the system?

  • Hazard Mitigation

  • 1. Detailed job description procedure (JHA, JSA, JRA, etc.) to be used in performing the above detailed work:*
  • 2. Description of the safe work practices to be employed:*
  • 3. Results of the shock hazard analysis:*
  • 4. Determination of shock protection boundaries:*
  • 5. Results of the flash hazard analysis:*
  • 6. Determination of the flash protection boundary:*
  • 7. Necessary personal protective equipment to safely perform the assigned task:*
  • 8. Means employed to restrict the access of unqualified persons from the work area:*
  • 9. Evidence of completion of job briefing including discussion of any job-related hazards:*
  • 10. Do you agree the above described work can be done safely?*

  • Approvals

    All the following approvals are required prior to starting work!
  • Superintendent Approval*
  • PM Approval*
  • RVP Approval*
  • VP HSE Approval*

  • *STOP*

    Based on the above answers you provided, you are not qualified to perform Energized Electrical Work for the Company!!!

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