Contact With Electricity CCFV

• Site conducted

• Date and Time

  Date

• Task

• Work location
  Address

• Conducted on

• Prepared by

Access Control

• 1. Is the “proximity/vicinity permit” being followed when working next to live HV Equipment

  Yes

  No

  N/A

• 2. Are the electrical cabinet panels/doors clear and accessible?

  Yes

  No

  N/A

• 3. Are controls in place to keep unauthorised people out of the work area?

  Yes

  No

  N/A

Isolation and Verification of Zero Energy

• 4. Is an approved isolation procedure being followed?

  Yes

  No

  N/A

• 5. Are all personal locks on the correct isolation point?

  Yes

  No

  N/A

• 6. Has the electrical isolation been verified by testing for the absence of voltage? E.g. using a multimeter or approved device.

  Yes

  No

  N/A

• 7. Has the test instrument been checked on a known 'live' source before<br>and after the test for the absence of voltage?

  Yes

  No

  N/A

• 8. Has the team confirmed there is no risk of inadvertent contact with<br>exposed live parts within the work area?

  Yes

  No

  N/A

• 9. For un-isolated work (including testing and fault finding), is an approved<br>procedure being followed?

  Yes

  No

  N/A

• 10. Have all energy sources been identified, isolated and checked for zero<br>energy?

  Yes

  No

  N/A

• 11. Are all isolation points identified clearly?

  Yes

  No

  N/A

Electrical PPE

• 12. Is the correct Arc Flash rated PPE to work in this location being worn<br>e.g. CAT 0, 1, 2 or 4?

  Yes

  No

  N/A

• 13. Is all electrical PPE in good condition and safe for use? e.g. free from<br>damage and contaminants (such as water, grease and oil)

  Yes

  No

  N/A

• 14. If voltage rated gloves are being used, are they within their test date<br>and appropriate for the task i.e. rated?

  Yes

  No

  N/A

Electrical Protection

• 15. Are the most recent single line and electrical drawings being used?

  Yes

  No

  N/A

• 16. Has the team verified the portable earthing equipment in use is<br>properly connected and tested?

  Yes

  No

  N/A

• 17. When using plug in electrical equipment, are all socket outlets protected<br>by appropriate earth leakage protection e.g. Residual Current Devices<br>(RCDs)?

  Yes

  No

  N/A

Non-Conductive Tools and Equipment

• 18. Are the tools and equipment being used adequate for the task? i.e.<br>appropriate voltage rating, free from defects, unmodified

  Yes

  No

  N/A

• Add signature

  Sign

• Yes

  No

  N/A