Inglett & Stubbs Energized Electrical Work Permit

• Document No.

• Job Name & Number:

• Conducted on

  Date

Part 1 to be completed by Requester

Description of circuit/equipment/job location:

Description of work to be done:

Justification of why the circuit/equipment cannot be de-energized or the work deferred until the next scheduled outage:

Requester Signature

• Add signature

  Sign

Part 2 to be completed by the qualified persons doing the work

Detailed job procedure to be used in performing the previously detailed work:

Description of the Safe Work Practices to be employed:

Results of the Shock Hazard Analysis:

Determination of Shock Protection Boundaries:

Results of the Flash Hazard Analysis:

Determination of the Flash Protection Boundary:

Necessary PPE to safely perform the assigned task:

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

Evidence of completion of a Job Briefing including discussion if any job related hazards:

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

  Yes

  No

Qualified persons doing the work signatures

Electrically Qualified Person

• Electrically Qualified Person

  Sign

• Date

  Date

Job Breifing

• The job briefing is to be reviewed by the Foreman/General Foreman with all employees involved before each job requiring energized electrical. All employees are to sign the briefing form before start of work.

Identify

• The hazards

• The voltage levels involved

• Skills required

• Any "foreign" (secondary) voltage source

• Any unusual work conditions

• Number of people needed to do the job

• The shock protection boundaries

• The available incident energy

• Potential for arc flash (Conduct an arc flash-hazard analysis)

• Arc flash protection boundary

• Has energized electrical permit been completed and signed?

Ask

• Can the equipment be de-energized?

  Yes

  No

• Are backfeeds of the circuits to be worked on possible?

  Yes

  No

• Is a "standby person" required?

  Yes

  No

Check

• Job Plans

• Single-line diagrams and vendor prints

• Safety procedures

• Individuals are familiar with facility

Job Briefing Continued

Know

• What the job is

• Who else needs to know --- Communicate!

• Who is in charge

Think

• About the unexpected event....What if?

• Lock - Tag - Test - Try

• Test for voltage FIRST

• Use the right tools and equipment, including PPE

• Install and remove grounds

• Install barriers and barricades

• What else...?

Prepare for an emergency

• Is the standby person CPR trained?

  Yes

  No

• Is the required emergency equipment available?

  Yes

  No

• Where is it?

• Where is the nearest telephone?

• Where is the fire alarm?

• Is confined space rescue available?

  Yes

  No

• What is the exact work location?

• How is the equipment shut off in an emergency?

• Are the emergency telephone numbers known?

  Yes

  No

• Where is the fire extinguisher?

• Are radio communications available?

  Yes

  No

Signatures

• Foreman/General Foreman

  Sign

• Select date

  Date
Employee Signature

• Add signature

  Sign

• Select date

  Date

Part 3 Approval to perform the work while electrically energized

• May only be signed by:
  General Superintendent-Division Manager-Vice President-President

• Signature

  Sign

• Title

• Select date

  Date

Example #1 Installing Breakers

• Example #1

  

Example #2

• Example #2