Energized Electrical Work Permit - GES

• Issuance Date and Time

  Date

• Expiration Date and Time

  Date

• Voltage of Work

  Select 120 208 240 277 460 480

  • 120
  • 208
  • 240
  • 277
  • 460
  • 480
• Work Location
  Address

• Prepared by

• Personnel

ANSWER THE FOLLOWING

• Describe the circuit, equipment and location that work will be perfomed

• Describe the work to be performed

• Can it be de- energized?

  yes

  no

• Why not?

• Have all affected personnel in the area been notified of the energized electrical work?

  Yes

  No

  N/A

• How did we communicate the hazards?

  Select Effective Means using two way radios Notifying store personnel and management Notifying GC of all hazards associated with this task Acquiring energized permit from PM and Safety Department

  • Effective Means using two way radios
  • Notifying store personnel and management
  • Notifying GC of all hazards associated with this task
  • Acquiring energized permit from PM and Safety Department

• Have all energized lines been insulated or covered?

  Yes

  No

  N/A

• why not?

• What type of platform will be used to perform task?

  scissor lift

  Boom lift

  Baker scaffold

  other

  NA

• What type of platform

• Is there a second person on the job?

  yes

  no

• STOP do not proceed and re-evaluate task when back up person is present

• Is that person CPR/ First aid trained?

  yes

  no

• STOP D NOT CONTINUE. Back up person MUST be trained.

• Is second person wearing protective Gear?

  Yes

  No

  N/A

• STOP second person MUST wear protective gear if they are going inside boundaries!

• Is lockout/tagout required and used?

  yes

  no

• JBI LOTO procedure compliant?

  yes

  no

• Why not?

• Are all flammables and possible obstructions removed from the area?

  Yes

  No

  N/A

• Why not

  Media

Risk Assessment

• Click + to add hazard identified

Hazard

• Description of hazard

  Select Arc flash Arc blast

  • Arc flash
  • Arc blast

• Enter description of other hazard identified

• What voltage will personnel be exposed to.

  Select 120 /208 V 120/240 V 277/480 V 600 V

  • 120 /208 V
  • 120/240 V
  • 277/480 V
  • 600 V

• People at Risk

• Controls

  Select Proper PPE Approach boundaries Back up person Long stick Blankets

  • Proper PPE
  • Approach boundaries
  • Back up person
  • Long stick
  • Blankets

• 5 x 5 RISK MATRIX GUIDELINES

  

• REFERENCE

  

• Risk Rating

• Qualified person's actions to further reduce risk

  Select weariness, exhaustion, or distraction can affect safe performance. Ability to recognize warning signs, Attentiveness to self, others and the situation Recognizing when the risk of potential electrical hazard is unacceptable Understanding the sequence of events that can lead to exposure to an electrical hazard (shock, arc flash, arc blast) Being alert to other personnel that can enter the work area Realizing that work conditions could change

  • weariness, exhaustion, or distraction can affect safe performance.
  • Ability to recognize warning signs, Attentiveness to self, others and the situation
  • Recognizing when the risk of potential electrical hazard is unacceptable
  • Understanding the sequence of events that can lead to exposure to an electrical hazard (shock, arc flash, arc blast)
  • Being alert to other personnel that can enter the work area
  • Realizing that work conditions could change

• What is the arc flash PPE category and Arc flash boundary you will be utilizing?

  Select Category 1 - 19 in. category 2 - 3ft. category 2 - 5 ft. Category 4 - 14 ft. Category 4 - 20 ft. Category 2 - 5 ft. Category 4 - 40 ft. Category 4 - 40 ft. N/A (doors closed) - NA Category 4 (doors open) - 40 ft. Category 4 - 40 ft.

  • Category 1 - 19 in.
  • category 2 - 3ft.
  • category 2 - 5 ft.
  • Category 4 - 14 ft.
  • Category 4 - 20 ft.
  • Category 2 - 5 ft.
  • Category 4 - 40 ft.
  • Category 4 - 40 ft.
  • N/A (doors closed) - NA
  • Category 4 (doors open) - 40 ft.
  • Category 4 - 40 ft.

• Add pictures of findings or inspected equipment.

  Media

• Has a JSA been completed

  yes

  no

The above items had been checked and the area is considered to be safe to proceed with the energized electrical work described above.

• Job Superintendent

  Sign

• General Superintendent

  Sign

• Health and Safety Director

  Sign

• VP Operations

  Sign

Work has been completed and equipment is back to normal. Permit is removed from the field.

• Job Superintendent

  Sign

• Health and Safety Director

  Sign

Job Safety Analysis

• Prepared by

• Approved by

  PM via Phone

  Safety Director via phone

  PM

  Safety Director

  President

• SEQUENCE OF JOB STEPS

• POTENTIAL HAZARDS

  Select arc flash, arc blast electrocution falls other

  • arc flash, arc blast electrocution
  • falls
  • other

• Please explain

• Required PPE

  class 0

  Class 1

  Class2

  Class3

  Other

• PPE inspection performed?

  Compliant

  Non-Compliant

  N/A

• Recommended Action or Procedure to eliminate potential hazards

• Start time

  Date

• Finish time

  Date