LVAP: Low Voltage Systems Permit

• Document number

Please call an LVAP to notify before any works takes place, once notified please fill out below and call LVAP to countersign once happy with evidence given.

• Site conducted

  Select

• Please state site details if not listed above

• Name of Permit Holder

• Name of LVAP Issuing Permit

• Description of task being undertaken including any circuit details and/or locations (reason for permit)

• PPE required for task (please refer to Anescos PPE matrix)

NO OTHER WORK ACTIVITY IS VALID UNDER THIS PERMIT OTHER THAN THAT STATED HERE

Isolation

• Notification – Has the customer/client/portfolio manager been made aware of the isolation and the works to be carried out? (Please state details of persons below)

• Isolation - State all point(s) of isolation including circuit designation and photo evidence of all LOTO/warning notices

• Confirmation - Prove equipment is safe to work on– State what test(s) have been made, where and with what instruments

NO PERMIT CAN BE VERIFIED WITHOUT EVIDENCE OF ISOLATION

• Please state any other precautions taken if applicable.

• LVAP Authorisation: I hereby declare that the above safety precautions and risks identified in the permit holders stage 1 & 2 risk assessment have been made known to the Competent Person in charge of the work. I consider that the apparatus specified above is safe to Work on.

  Sign

Acceptance

• Acceptance: I acknowledge receipt of this Permit and understand the safety precautions as details in the LV Safety Rules. I have witnessed the isolations made and the circuit / system proved Dead. Neither I nor the personnel under my control will work on any other electrically dangerous apparatus. I will return this Permit to the Authorised Person when the work is complete. In the event of an emergency I will cease the work safely and comply with the Site emergency procedures.

  Sign

• Additional personnel (Permit signatories): We accept this permit and will apply all precautions listed and adhere to control measures in place.

  Yes

  N/A

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

Cancellation

• I herby declare that the work detailed above has been completed, personnel and equipment withdrawn. The site has been left in a safe and tidy condition.

  Yes

  No

• The site must be left in a safe condition

• Personal cancelling permit

  Sign

Closure

• LVAP: I hereby declare this Permit closed. The Permit has been returned to me by the Competent Person. I am satisfied the equipment that was being worked on is safe for continued use and the work area has been cleared.

  Sign

LVAP: Once permit has been finalised please proceed to download completed file and document within the teams folder created by the LVAE