Electrical Pre-Task Plan

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Are you working on an HVAC units/equipment pushing 480 volts or less

  Yes

  No

  N/A

• Do you have the required PPE?

  Yes

  No

  N/A

• 8 cal/cm2 Arc Rated Coveralls or Long Sleeve Shirt and Pants

• 8 Cal/cm2 Arc Rated Face Shield

• Class E Hard Hat

• 8 cal/cm2 Balaclava

• Class 00 Rubber Gloves and Currently Inspected (Enter date)

  Date

• Leather Protector Gloves

• Safety Glasses

• Ear Plugs

• Leather or properly tested footwear

• STOP AND GET THE REQUIRED PPE!

  Sign

• Can this equipment be de-energized?

  Yes

  No

  N/A

• Perform 6 Steps for Establishing an Electrically Safe Work Condition

• 1. Identify power sources

  Safe

  At Risk

  N/A

• 2. Disconnect power sources

  Safe

  At Risk

  N/A

• 3. Verify that power is off

  Safe

  At Risk

  N/A

• 4. Lockout/Tagout

  Safe

  At Risk

  N/A

• 5. Verify again that power is off

  Safe

  At Risk

  N/A

• Discharge stored electrical energy

  Safe

  At Risk

  N/A

• Energized Work Only Allowed When

• De-energizing introduced a Greater Hazard

  Yes

  No

  N/A

• De-energizing is Infeasble due to equipment design or operational limitations

  Yes

  No

  N/A

• Equipment operates at less than 50V

  Yes

  No

  N/A

Will you be doing the following tasks?

• Will you be doing one of the following; Pulling Wire, Drilling Holes, Tapping Bus Plugs, Running Pipe or Racking Breakers/MCCs

  Yes

  No

  N/A

• Energized Electrical Work Permit Required, Follow label for hazards, Apply appropriate PPE

• Proceed to Work Safely

  Sign

• Will you Only be Testing Troubleshooting or Voltage Measuring?

  Yes

  No

  N/A

• Energized Electrical Work Permit Required

• Follow label for hazards, Apply appropriate PPE and Proceed to Work SAFELY

  Sign

• Follow label hazards, Apply appropriate PPE

• Proceed to Work SAFELY

  Date