Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

General Informations

  • Who are you auditing today?

  • What is the name of the external subcontractor?

  • What is the company name?

  • 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?

  • Why the procedure have not been followed?

  • Is the external subcontractor qualified for energized electrical Work?

  • Notify the supervisor of maintenance immediately

  • Take a photo of the signed commitment form

  • Is the worker qualified for energized electrical Work?

  • Why he is not on the list?

  • What's the job to be done?

  • Have all affected personal in the area been notified on the energized electrical work?

  • When the energized permit is required, incident energy ˃1.2 cal/cm², has the permit been filled properly and authorized?

  • Take a photo of the permit

  • Take a photo of the permit

  • Notified immediately the supervisor

  • Means have been employed to restrict the access of unqualified persons from the work area?

  • Take a picture

  • Why the procedure have not been followed?

  • Safety perimeter or barricade is placed at a distance less than the limited approach boundary (3'6)

Energized Electrical Work - Arc Flash Hazard Asessment

  • Is a warning label placed on the electrical cabinet on which energized electrical work will be perform?

  • Take a photo of the warning label

  • Table method is used to assess the risk?

  • Does the qualified worker wearing proper PPE in accordance with the table method?

  • 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)

  • Notify the supervisor immediately

  • Take a photo of the worker with Arc rated PPE

  • All parts of the body are protected?

  • All jewellery, piercings, watched or any metal accessories have been removed?

Energized Electrical Work - Shock Hazard Assessment

  • The work to be performed is within the restricted approach boundary? (≤12in)?

  • The qualified worker wearing voltage rated glove, Class OO, 1000 Volt in addition to a pair of leather glove?

  • Take a picture of the gloves

  • Insulated tools and equipment required within the restricted approach boundary are using?

  • Worker is using a category III 1000V multimeter?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.