BGIS Minimum Controls Checklist - Electrical Low Voltage

• Date and Time

  Date
• Work Order / Project Number
  Address

• Full Name

• Contact Number

• Site Address
  Address

• Electrical Licence Number

• Location of Works

  Yes

  No

  N/A

• Description of the work

• List the equipment being isolated / worked on

  Yes

  No

  N/A

Confirm the following is in place

• SWMS reviewed in consultation with work group

  Yes

  No

  N/A

• Work area cordoned off or barricaded / warning signs in place

  Yes

  No

  N/A

• Emergency exits / muster points / contigency plans in place and understood

  Yes

  No

  N/A

Isolation, Lock Out and Tag Out Controls (Select relevant control in place)

• All parts treated as live until isolated

  Yes

  No

  N/A

• Isolating with Locks on switches

  Yes

  No

  N/A

• Isolating with Tags on switches

  Yes

  No

  N/A

• Isolations will be checked and verified (without placing anyone at risk)

  Yes

  No

  N/A

• Electrical isolations include testing of multi-meter, checking circuit (live/dead side) & attempted activation of equipment

  Yes

  No

  N/A

• Impacted work have been consulted

  Yes

  No

  N/A

• Other (Please detail)

• Isolation has been verified

  Yes

  No

• Isolation must be verified before beginning work. If this is not done, the job must not begin

• Isolation register completed (Where required)?

  Yes

  No

  N/A

• Please detail any other controls in place

Sign Off

• Full Name

• Date and Time

  Date

• Signature

  Sign