EFS Energized Electrical Work Permit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job/Work Order Number

Part 1 - To Be Completed By The Requester:

• Description of circuit/equipment/job location:

• Description of work to be done:

• Justification of why the circuit/equipment cannot be de-energized. (Greater Hazard/Infeasible).

• Requester and Title

• Select date

  Date

Part II - To Be Completed By The Electrically Qualified Persons Doing The Work:

• Detailed job description procedure to be used in performing the above detailed work:

• Description of the safe work practices to be used:

• SHOCK HAZARD ANALYSIS (for Alternate-Current Systems)

  Safe

  At Risk

  N/A

• Approach Boundaries - What voltage range are you working with?

  Select <50 V 50V-300V 301V-750V 751V-15kV 15.1kV-36kV 36.1kV-46kV 46.1kV-72.5kV 72.6kV-121kV 138kV-145kV 161kV-169kV 230kV-242kV 345kV-362kV 345kV-362kV 500kV-550kV 765kV-800kV

  • <50 V
  • 50V-300V
  • 301V-750V
  • 751V-15kV
  • 15.1kV-36kV
  • 36.1kV-46kV
  • 46.1kV-72.5kV
  • 72.6kV-121kV
  • 138kV-145kV
  • 161kV-169kV
  • 230kV-242kV
  • 345kV-362kV
  • 345kV-362kV
  • 500kV-550kV
  • 765kV-800kV

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  Limited Approach - Not Specified
  
  Restricted Approach - Not Specified
  
  Restricted Approach - Not Specified

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary.
  
  
  Limited Approach Boundary = 10 feet for movable conductor or 3' 6" for fixed circuit part
  
  Restricted Approach Boundary = Avoid Contact
  
  Prohibited Approach Boundary = Avoid Contact

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 10 feet for movable conductor or 3' 6" for fixed circuit part
  
  Restricted Approach Boundary = 1'0"
  
  Prohibited Approach Boundary = 0'1"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 10 feet for movable conductor or 5'0" for fixed circuit part
  
  Restricted Approach Boundary = 2'2"
  
  Prohibited Approach Boundary = 0'7"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 10 feet for movable conductor or 6'0" for fixed circuit part
  
  Restricted Approach Boundary = 2'7"
  
  Prohibited Approach Boundary = 0'10"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 10 feet for movable conductor or 8'0" for fixed circuit part
  
  Restricted Approach Boundary = 2'9"
  
  Prohibited Approach Boundary = 1'5"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 10 feet for movable conductor or 8'0" for fixed circuit part
  
  Restricted Approach Boundary = 3'3"
  
  Prohibited Approach Boundary = 2'2"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 10'8" for movable conductor or 8'0" for fixed circuit part
  
  Restricted Approach Boundary = 3'4"
  
  Prohibited Approach Boundary = 2'9"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 11'0" for movable conductor or 10'0" for fixed circuit part
  
  Restricted Approach Boundary = 3'10"
  
  Prohibited Approach Boundary = 3'4"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 11'8" for movable conductor or 11'8" for fixed circuit part
  
  Restricted Approach Boundary = 4'3"
  
  Prohibited Approach Boundary = 3'9"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 13'0" for movable conductor or 13'0" for fixed circuit part
  
  Restricted Approach Boundary = 5'8"
  
  Prohibited Approach Boundary = 5'2"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 15'4" for movable conductor or 15'4" for fixed circuit part
  
  Restricted Approach Boundary = 9'2"
  
  Prohibited Approach Boundary = 8'8"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 19'0"for movable conductor or 19'0" for fixed circuit part
  
  Restricted Approach Boundary = 11' 10"
  
  Prohibited Approach Boundary = 11' 4"

• Where one or more unqualified persons are working at or close to the Limited Approach Boundary, the designated person in charge of the work space where the electrical hazard exists shall advise the unqualified person(s) of the electrical hazard and warn him or her to stay outside of the Limited Approach Boundary
  
  
  Limited Approach Boundary = 23'9" for movable conductor or 23'9" for fixed circuit part
  
  Restricted Approach Boundary = 15'11"
  
  Prohibited Approach Boundary = 15"5"

• HAZARD/RISK CLASSIFICATION

  Safe

  At Risk

  N/A

• Tasks Performed on Energized Equipment

  240 Volts and Below

  240 Volts up to 600 Volts

  600 V MCC's