Schneider Electric POWRA & LOTTO

• Prepared by

  Risk_Assessment_Report
• Location
  Address

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

  Yes

  No

  N/A

• Date

  Date

• Project Title

• Project Number

• Applicable Risk Assessments supplied

  Yes

  No

  N/A

• Have you read the Task Specific Risk Assessment supplied.

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• Signature Lead Engineer

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• IF IN DOUBT ASK

LOTO

• Is LOTO required for this job

  Yes

  No

  N/A

• SE’s Person in Charge:

• Customer’s Person in Charge:

• SE Work Team names

• Site Name

• Customer Name:

• Date:

  Date

Step 0 - Preparation

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

  Yes

  No

  N/A

• Briefing with customer’s person in charge?

  Yes

  No

  N/A

• Correctly rated voltage tester available?

  Yes

  No

  N/A

• Earthing (grounding) equipment available if required?

  Yes

  No

  N/A

• Checked & Signed by SE Person in Charge:

• Adequate lock out devices and padlocks available?

  Yes

  No

  N/A

• Emergency exit & fire extinguishers available?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Access to working area restricted with barriers & signs?

  Yes

  No

  N/A

• Is SF6 gas present refer to procedure?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Drawing

• Switching schedule (sequence of operations) defined?

  Yes

  No

  N/A

• Checked & Signed by SE Person in Charge:

  Sign

Step 1. Remove Load

• Shut down the load in the normal way?

  Yes

  No

  N/A

• Local/remote control disconnected?

  Yes

  No

  N/A

• Remove the load Approved by Customer Person in Charge

  Yes

  No

  N/A

Step 2. Separation (Dead)

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the Utility grounded the lines?

  Yes

  No

  N/A

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)?

  Yes

  No

  N/A

• Tag fitted on each device?

  Yes

  No

  N/A

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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Voltage tester tested after use?

  Yes

  No

  N/A

• Customer’s person in charge present?

  Yes

  No

  N/A

• Checked & Signed by SE Person in Charge:

  Sign

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)

  Yes

  No

  N/A

• Capacitors discharged?

  Yes

  No

  N/A

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

• Checked & Signed by Customer Person in Charge:

  Sign

Step 6. Protect adjacent energized circuits

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

  Yes

  No

  N/A

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

  Date

• Time

  Date

• Signed by SE Person in Charge

  Sign

• 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

  Yes

  No

  N/A

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign

• Signature

  Sign