Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
General Informations
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Who are you auditing today?
- Danielle Maltais
- Roger Gabbert
- External Subcontractor
- Other
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What is the name of the external subcontractor?
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What is the company name?
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Does the external subcontractor signed, prior to the work, the "Cascades Commitment Form" confirming he is trained and qualified to carry out energized electrical work?
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Why the procedure have not been followed?
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Is the external subcontractor qualified for energized electrical Work?
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Notify the supervisor of maintenance immediately
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Take a photo of the signed commitment form
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Is the worker qualified for energized electrical Work?
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Why he is not on the list?
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What's the job to be done?
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Have all affected personal in the area been notified on the energized electrical work?
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When the energized permit is required, incident energy ˃1.2 cal/cm², has the permit been filled properly and authorized?
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Take a photo of the permit
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Take a photo of the permit
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Notified immediately the supervisor
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Means have been employed to restrict the access of unqualified persons from the work area?
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Take a picture
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Why the procedure have not been followed?
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Safety perimeter or barricade is placed at a distance less than the limited approach boundary (3'6)
Energized Electrical Work - Arc Flash Hazard Asessment
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Is a warning label placed on the electrical cabinet on which energized electrical work will be perform?
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Take a photo of the warning label
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Table method is used to assess the risk?
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Does the qualified worker wearing proper PPE in accordance with the table method?
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Does the qualified worker wearing proper PPE in accordance with the equipment labelling? Rule : Arc rating PPE must be equal to or greater than the incident energy exposure level (cal/cm²)
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Notify the supervisor immediately
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Take a photo of the worker with Arc rated PPE
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All parts of the body are protected?
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All jewellery, piercings, watched or any metal accessories have been removed?
Energized Electrical Work - Shock Hazard Assessment
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The work to be performed is within the restricted approach boundary? (≤12in)?
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The qualified worker wearing voltage rated glove, Class OO, 1000 Volt in addition to a pair of leather glove?
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Take a picture of the gloves
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Insulated tools and equipment required within the restricted approach boundary are using?
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Worker is using a category III 1000V multimeter?