FENJ Job Briefing Checklist & Energized Electrical Work Permit Rev. 0

• Document No.

• Audit Title

• Client / Site / Job #

• Conducted on

  Date

• Prepared by

• Location
  Address

Identify

• Hazards

• Voltage Levels Involved

• Skills Required

• Any Foreign (Secondary Source) Voltage

• Any Unusual Work Conditions

• Number Of People Required To Do Job

• Shock Protection Boundaries

• Available Incident Energy

• Potential For Arc Flash (Conduct An Arc Flash Hazard Analysis)

• Arc Flash Boundary

Ask

• Can The Equipment Be De-Energized

• Are Back Feeds Of The Circuits To Be Worked On Possible

• Is A Standby Person Required

Check

• Check One Lines And Vendor Drawings

• Status Board

• Information On Plant & Vendor Resources Up To Date

• Safety Procedures

• Vendor Information

• Individuals Familiar With The Facility

Know

• What The Job Is

• Who Is The Boss

• Who Else Needs To Know - Communicate!

Think

• About The Unexpected......What If

• Lock - Tag - Test - Try

• Test For Voltage FIRST!!

• Use The Right Tools And Equipment Including PPE

• Install And Remove Temporary Protective Grounding Equipment

• Install Barriers And Barricades

• What Else.......?

Prepare For An Emergency

• Is The Standby Person CPR Trained

• Is The Required Emergency Equipment Available? Where Is It?

• Is Your Cell Phone Fully Charged And Do You Have A Good Signal

• Where Is The Fire Alarm

• Is Confined Space Rescue Available

• What Is The Exact Work Location

• How Is The Equipment Shut Off In An Emergency

• Are The Emergency Telephone Numbers Known

• Where Are The Fire Extinguishers

• Are Radio Communications Available

PART 1 TO BE COMPLETED BY THE REQUESTER

• Description of circuit/equipment

• Description of work to be done

• Justification of why the circuit/ equipment can't be de-energized or the work deferred until the next outage

• Requester

  Select Owner GC/CM Forest Electric FENJ Project Manager FENJ Superintendent FENJ Foreman

  • Owner
  • GC/CM
  • Forest Electric
  • FENJ Project Manager
  • FENJ Superintendent
  • FENJ Foreman

• Today's date

  Date

PART 2 TO BE COMPLETED BY THE ELECTRICALLY QUALIFIED PERSONS DOING THE WORK

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

• Description of the safe work practices to be employed

• Give the name, date and revision number is the MOP that will be used.

Results of the shock risk assessment

• Voltage to which personnel will be exposed to

  Select <100V 100V - 300V 301V - 1KV 1.1KV - 5KV 5KV - 15KV 15.1 KV - 45KV 45.1KV - 75KV 75.1KV - 150KV 150.1KV - 250KV 250.1KV - 500KV 500.1KV - 800KV

  • <100V
  • 100V - 300V
  • 301V - 1KV
  • 1.1KV - 5KV
  • 5KV - 15KV
  • 15.1 KV - 45KV
  • 45.1KV - 75KV
  • 75.1KV - 150KV
  • 150.1KV - 250KV
  • 250.1KV - 500KV
  • 500.1KV - 800KV

• Limited approach boundary

  Select 3 ft 6 in 5 ft 8 ft 10 ft 10 ft 8 in 11 ft 8 in 20 ft 26 ft Not Specified

  • 3 ft 6 in
  • 5 ft
  • 8 ft
  • 10 ft
  • 10 ft 8 in
  • 11 ft 8 in
  • 20 ft
  • 26 ft
  • Not Specified

• Restricted approach boundary

  Select Not Specified Avoid Contact 1 ft 1 ft 5 in 2 ft 2 in 2 ft 9 in 3 ft 2 in 4 ft 5 ft 3 in 11 ft 6 in 16 ft 5 in

  • Not Specified
  • Avoid Contact
  • 1 ft
  • 1 ft 5 in
  • 2 ft 2 in
  • 2 ft 9 in
  • 3 ft 2 in
  • 4 ft
  • 5 ft 3 in
  • 11 ft 6 in
  • 16 ft 5 in

• Necessary shock, personal and other protective equipment to safely perform the assigned work

Results of the arc flash risk assessment

• Available incident energy at the working distance or arc flash PPE category

• Necessary arc flash personal and other equipment to safety preform the assigned task

  Select 11 cal arc rated suit 40 cal arc rated suit 50 cal arc rated suit 75 cal arc rated suit 100 cal arc rated suit class 00 gloves with leather protectors class 0 gloves with leather protectors class 1 gloves with leather protectors class 2 gloves with leather protectors class 3 gloves with leather protectors class 4 gloves with leather protectors multimeter high voltage contact tester high voltage non-contact tester discharge stick shotgun stick hook stick ground set insulating blanket cuttable insulted blanket roll dielectric shoe covers truck ground set amprobe remote cable cutter LOTO equipment

  • 11 cal arc rated suit
  • 40 cal arc rated suit
  • 50 cal arc rated suit
  • 75 cal arc rated suit
  • 100 cal arc rated suit
  • class 00 gloves with leather protectors
  • class 0 gloves with leather protectors
  • class 1 gloves with leather protectors
  • class 2 gloves with leather protectors
  • class 3 gloves with leather protectors
  • class 4 gloves with leather protectors
  • multimeter
  • high voltage contact tester
  • high voltage non-contact tester
  • discharge stick
  • shotgun stick
  • hook stick
  • ground set
  • insulating blanket
  • cuttable insulted blanket roll
  • dielectric shoe covers
  • truck ground set
  • amprobe
  • remote cable cutter
  • LOTO equipment

• Arc flash boundary

  Select 19 in 3 ft 5 ft 14 ft 20 ft 40 ft

  • 19 in
  • 3 ft
  • 5 ft
  • 14 ft
  • 20 ft
  • 40 ft

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

  Select lock door danger tape hard barrier spotter cones with danger tape

  • lock door
  • danger tape
  • hard barrier
  • spotter
  • cones with danger tape

• Evidence of completion of a job briefing, including discussion of any job related hazard

• Do you agree the above described work can be done safely

  Yes

  No

• Work can't be done, return form to the requester

• Electrically qualified person(s)

  Sign

• Electrically qualified person(s)

  Sign

PART 3 APPROVAL(S) TO PERFORM THE WORK WHILE ELECTRICALLY ENERGIZED

• Harry Sassaman

  Sign

• FENJ Project Manager

  Sign

• FENJ Superintendent

  Sign

• FENJ Safety Manager

  Sign

• Foreman

  Sign

• Owner

  Sign

• CM/GC

  Sign