Qualified Electrical Worker Evaluation - GES

• Site conducted

  Select

• Qualified Electrical Worker

• A Qualified Electrical Worker "has demonstrated" skills and knowledge related to the construction and operation of electrical equipment and has received safety training to identify and avoid the risks/hazards involved. Each employee who performs energized electrical work shall have completed this Qualified Electrical Worker Checklist in order to approach specific boundaries from exposed energized electric parts.

• Conducted on

  Date

• Prepared by

• Location
  Address

Team member Is:

• Equipped with proper training and equipment (e.g. PPE shall be Cat II or greater, independent testing laboratory certified) to perform the job safely.

  Yes

  No

  N/A

• Certified in First Aid/CPR/AED

  Yes

  No

  N/A

Team Member Has Demonstrated Ability To:

• Demonstrate the decision-making process necessary to perform: job safety planning, risk assessment, and voltage testing for the purpose of establishing a safe work condition.

  Yes

  No

  N/A

• Implement Hierarchy of Controls.

  Yes

  No

  N/A

• List all controls implemented:

  Select Elimination: Creating an electrically safe work condition. Substitution: Opting for less hazardous equipment, such as non-electrical or battery operated tools. Engineering: Can automatically reduce risks, such as GFCI protection and insulated barriers. Awareness: Requires that people be alerted to the hazard, such as installing signs, labels or barricades. Administrative: Process of training, planning, permits, and procedures to create safer conditions. PPE: Available as a ‘last resort’ method, when needed, to reduce potential severity of harm.

  • Elimination: Creating an electrically safe work condition.
  • Substitution: Opting for less hazardous equipment, such as non-electrical or battery operated tools.
  • Engineering: Can automatically reduce risks, such as GFCI protection and insulated barriers.
  • Awareness: Requires that people be alerted to the hazard, such as installing signs, labels or barricades.
  • Administrative: Process of training, planning, permits, and procedures to create safer conditions.
  • PPE: Available as a ‘last resort’ method, when needed, to reduce potential severity of harm.

• Distinguish exposed energized conductors and circuit parts from other equipment parts

  Yes

  No

  N/A

• Determine the nominal voltage of exposed energized conductors and circuit parts

  Yes

  No

  N/A

• Select the PPE that this electrical worker is provided and is able determine is necessary:
  PPE Shall be issued and sized to fit each qualified electrical worker (e.g. VR gloves and AR coverall).
  Note: Clothing underneath PPE shall be 100% natural fibers (e.g. cotton). Remove any/all metals from your person!

• Check meter prior to utilization on live circuit

  Qualified

  Unqualified

• PPE Category 2:<br>Minimum of 8 cal/cm2 AR shirt, face shield <br>< 500V: Class 00 VR Gloves with Leather-overs

  Yes

  No

  N/A

• AC Systems: Panelboards or equipment rated 110 < 240V*1<br>PPE Category: 2<br>Flash Boundary: 42"

  Qualified

  Unqualified

• is able to identify the breaker and apply JBI LOTO procedure (two lock / two tag process)

  Qualified

  Unqualified

• Read schematics and one line diagrams to locate a particular circuit.

  Qualified

  Unqualified

• Is able to detect induced voltage and load on neutral in order to establish a safe work condition (Phase to Phase, Phase to Neutral, Phase to Ground, Neutral to Ground)

  Qualified

  Unqualified

• If you have multiple Neutrals joined together, disconnect and test each induvial Neutral to Ground to check load.

  Qualified

  Unqualified

• Is able to inspect PPE and make sure he has the protection necessary for the voltage he will be working on.

  Qualified

  Unqualified

• By signing this, I acknowledge that I understand how to properly test for induce voltage, test for load on neutral. I acknowledge that I will properly test every circuit properly for myself and every unqualified person I am leading in LOTO.

  Sign

Team Member Understands:

• How to identify potential electrical risks/hazards and safe work procedures that shall be followed

  Yes

  No

  N/A

• Does he Understands description of the circuit or equipment should be available at the job location ?

  Yes

  No

  N/A

• Normal operation of a circuit breaker (CB), switch, contactor or starter

  Qualified

  Unqualified

• Removal or installation of covers for equipment such as junction boxes, that does not expose bare energized electrical conductors and circuits

  Qualified

  Unqualified

• Opening or removal of bolted covers (to expose bare energized electrical conductors and circuits).

  Qualified

  Unqualified

• Other

  Yes

  No

  N/A

• If Applicable, How to utilize insulated blankets to properly cover all potential energized parts

  Yes

  No

  N/A

• Why would you use blankets?

Acknowledgement

• By signing this form I acknowledge that I am qualified for certain tasks but not qualified for others. This evaluation is limited to PPE inspection voltage testing on potential energized circuits for the purposes of LOTO and establishing a safe work condition only .

• Team member signature

  Sign

• Evaluator

  Sign