Title Page

  • Prepared by

  • Location

POWRA

  • Are you well and capable of conducting the works required?

  • Date

  • Project Title

  • Project Number

  • Applicable Risk Assessments supplied

  • Have you read the Task Specific Risk Assessment supplied.

  • Are there additional hazards identified that are not in the RAMS Supplied ? (If no additional hazards are identified mark "No" and sign off this form)

  • Hazard/Risk

  • Control Measures Implemented

  • Hazard / Risk

  • Control Measures Implemented

  • Hazard / Risk

  • Control Measure Implemented

  • Hazard / Risk

  • Control Measure Implemented

  • IF THE HAZARD/RISK CANNOT BE CONTROLLED DO NOT PROCEED

  • Indicate number of persons at Risk

Employees

  • All persons must sign onto this Risk assessment. It must be ensured that the contents are fully discussed, agreed and understood by all

  • Signature Lead Engineer

  • Signature

  • Signature

  • Signature

  • IF IN DOUBT ASK

LOTO

  • Is LOTO required for this job

  • SE’s Person in Charge:

  • Customer’s Person in Charge:

  • SE Work Team names

  • Site Name

  • Customer Name:

  • Date:

Step 0 - Preparation

  • Drawings (single line, layout…) available/up to date?

  • Briefing with customer’s person in charge?

  • Correctly rated voltage tester available?

  • Earthing (grounding) equipment available if required?

  • Checked & Signed by SE Person in Charge:

  • Adequate lock out devices and padlocks available?

  • Emergency exit & fire extinguishers available?

  • Emergency numbers posted - first aid, fire brigades, etc?

  • Access to working area restricted with barriers & signs?

  • Is SF6 gas present refer to procedure?

  • Shock and arc flash PPE required for all steps, including opening doors and removing bolted covers?

  • Note* All circuits considered energized until step 6 is complete

  • Switching schedule (sequence of operations) defined?

  • Checked & Signed by SE Person in Charge:

Step 1. Remove Load

  • Shut down the load in the normal way?

  • Local/remote control disconnected?

  • Remove the load Approved by Customer Person in Charge

Step 2. Separation (Dead)

  • All phases/live conductors disconnected? Consider remote re-energisation, fuses removed, feedback from other source: Ring circuits, generators,

  • UPS, batteries, dual fed systems, mesh network, etc?

  • When the isolation point is the utility, is a SE worker present to witness isolation & place their lock on the isolation point?

  • Has the Utility grounded the lines?

Step 3. Securing Isolation (locking in open position)

  • Isolation point must be upstream of the cabinet where the work will take place, work in the same cabinet requires additional precautions (See step 6)

  • Padlocks fitted on all isolation devices (Each worker must place their own lock on each device after step 6 is complete. Group Lock Box can be used)?

  • Tag fitted on each device?

Step 4. Verification of absence of voltage (VAV)

  • Voltage tester rated at what Kv (calibration Voltage tester tested before use)

  • calibration Voltage tester tested before use?

  • Verification of absence of voltage on all conductors in each cabinet opened?

  • Voltage tester tested after use?

  • Customer’s person in charge present?

  • Checked & Signed by SE Person in Charge:

Step 5. Earthing (Grounding) and short-circuiting (Not mandatory below 1000v)

  • Earth cables connected to earth before short-circuiting Conductors? (Must be able to carry maximum fault current)

  • Capacitors discharged?

  • If feedback from other sources possible, at any voltage, earth cables connected before & after work area?

  • Checked & Signed by Customer Person in Charge:

Step 6. Protect adjacent energized circuits

  • Prevent access to adjacent energized circuits (That cannot be de- energized) with voltage rated sheeting?

After even the shortest interruption of the work process (i.e. visit to restroom, lunch, etc), carry out a visual check to ensure all controls are in place – locks, tags, barriers and Earthing (Grounding) and short-circuiting

All steps complete

  • Date

  • Time

  • Signed by SE Person in Charge

  • The full SE Work Team will “sign on” below to indicate that they all completed the entire step 0-6 in this process

  • All people working will Sign to confirm above

  • Signature

  • Signature

  • Signature

  • Signature

  • Signature

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.