SE&C Energized Electrical Work Permit Rev 1

• Document No.

• Audit Title

• Job name and number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Energized Electrical Work Permit Flow Chart

  

Part 1: Project information - to be completed by requester

• Select date

  Date

• Requester/ Title

• Project manager

• Host Employer

• SITE/BUILDING/ROOM/LOCATION

Equipment and/or circuit to be worked on

• Description of equipment and/or circuit

• Determine all possible sources of electrical supply to the specific equipment. Check applicable up-to-date drawings, diagrams, and identification tags. What is source #1

• Determine all possible sources of electrical supply to the specific equipment. Check applicable up-to-date drawings, diagrams, and identification tags. What is source #1

  Media

• Determine all possible sources of electrical supply to the specific equipment. Check applicable up-to-date drawings, diagrams, and identification tags. What is source #2 if applicable?

• Determine all possible sources of electrical supply to the specific equipment. Check applicable up-to-date drawings, diagrams, and identification tags. What is source #2 if applicable?

  Media

Part 2: To be completed by the electrically qualified persons doing the work

• Detailed job description procedure to be used in performing the work

• Optional. Upload detailed job description procedure to be used in performing the work

  Media

• Justification for energized work per 130.2 (A)

  (1) Additional Hazards or Increased Risk. Energized work shall be permitted where the employer can demonstrate that de-energizing introduces additional hazards or increased risk.

  (2) Infeasibility. Energized work shall be permitted where the employer can demonstrate that the task to be performed is infeasible in a de-energized state due to equipment design or operational limitations.

  (3) Equipment Operating at Less Than 50 Volts. Energized electrical conductors and circuit parts that operate at less than 50 volts shall not be required to be de-energized where the capacity of the source and any overcurrent protection between the energy source and the worker are considered and it is determined that there will be no increased exposure to electrical burns or to explosion due to electric arcs.

  (4) Normal Operating Condition.

Part 3: Risk Assessment Procedure

• Risk Assessment Flow Chart
  https://1drv.ms/b/s!AjFa1of5RTPEgYgBHfohnWToH8CiCw

• Shock Risk Assessment

• Nominal voltage to which personnel will be exposed

  Select 120/208 120/240 277/480 50v or less

  • 120/208
  • 120/240
  • 277/480
  • 50v or less

• Results of the shock hazard analysis. What are the hazards?

• Necessary shock, personal and other protective equipment to safety perform assigned task

  Select Rubber insulating gloves and leather protectors, Rubber insulating sleeves as needed Class G or E hard hat as needed Safety glasses or goggles as needed Dielectric overshoes as needed

  • Rubber insulating gloves and leather protectors,
  • Rubber insulating sleeves as needed
  • Class G or E hard hat as needed
  • Safety glasses or goggles as needed
  • Dielectric overshoes as needed

• Shock Protection Boundary

  

• TABLE 130.4(D)(a) Shock Protection Approach Boundaries to Exposed Energized Electrical Conductors or Circuit Parts
  for Alternating-Current Systems

  

• TABLE 130.4(D)(b) Shock Protection Approach Boundaries to Exposed Energized Electrical Conductors or Circuit Parts
  for Direct-Current Voltage Systems

  

• Restricted approach boundary (in feet) using Table 130.4(D)(a) or Table 130.4(D)(b)

• Limited approach boundary (in feet) using Table 130.4(D)(a) or Table 130.4(D)(b)

• Arc flash Risk Assessment

• TABLE 130.5(C) Estimate of the Likelihood of Occurrence of an Arc Flash Incident for ac and dc Systems

  

• TABLE 130.5(C) Estimate of the Likelihood of Occurrence of an Arc Flash Incident for ac and dc Systems. Continued

  

• Select arc flash risk assessment method. 130.5(F)

  PPE category method 130.7(C)(15)

  Incident energy analysis method 130.5(G)

• Calculate arc flash boundary and incident energy at working distance

• Determine required arc-rated PPE 130.7(C), 130.5(G)

• Table 130.5(G) identifies the arc-rated clothing and other PPE requirements of Article
  130 and shall be permitted to be used with the incident energy analysis method of selecting
  arc flash PPE

  

• Select all arc-flash required PPE.

  Select Arc-rated clothing with an arc rating equal to or greater than the estimated incident energy Long-sleeve shirt and pants or coverall or arc flash suit Arc-rated face shield and arc-rated balaclava or arc flash suit hood Arc-rated outerwear (e.g., jacket, parka, rainwear, hard hat liner) Heavy-duty leather gloves, arc-rated gloves, or rubber insulating gloves with leather protectors Hard hat Safety glasses or safety goggles Hearing protection Leather footwear

  • Arc-rated clothing with an arc rating equal to or greater than the estimated incident energy
  • Long-sleeve shirt and pants or coverall or arc flash suit
  • Arc-rated face shield and arc-rated balaclava or arc flash suit hood
  • Arc-rated outerwear (e.g., jacket, parka, rainwear, hard hat liner)
  • Heavy-duty leather gloves, arc-rated gloves, or rubber insulating gloves with leather protectors
  • Hard hat
  • Safety glasses or safety goggles
  • Hearing protection
  • Leather footwear

• Arc Flash Boundary identified by incident energy analysis. The arc flash boundary shall be constructed at a distance of ___________________from exposed energized parts.

• PPE Category Method

• AC - Confirm compliance with Table 130.7(C)(15)(a) conditions and parameters; DC - Confirm compliance with Table 130.7(C)(15)(b) conditions and parameters MUST CONFIRM COMPLIANCE WITH ALL PARAMETERS TO UTILIZE THIS METHOD. Tables below.

  Select Maximum of 25 kA available fault current maximum of 0.03 sec (2 cycles) fault clearing time minimum working distance 455 mm (18 in.)

  • Maximum of 25 kA available fault current
  • maximum of 0.03 sec (2 cycles) fault clearing time
  • minimum working distance 455 mm (18 in.)

• Obtain arc flash boundary and PPE category

• TABLE 130.7(C)(15)(a) Arc-Flash PPE Categories for Alternating Current (ac) Systems

  

• TABLE 130.7(C)(15)(b) Arc-Flash PPE Categories for Direct Current (dc) Systems

  

• Select Arc-Flash PPE Category

  Arc-Flash PPE Category 1

  Arc-Flash PPE Category 2

  Arc-Flash PPE Category 3

  Arc-Flash PPE Category 4

• Select all arc-flash required PPE.

  Select Arc-rated clothing with an arc rating equal to or greater than the estimated incident energy Long-sleeve shirt and pants or coverall or arc flash suit Arc-rated face shield and arc-rated balaclava or arc flash suit hood Arc-rated outerwear (e.g., jacket, parka, rainwear, hard hat liner) Heavy-duty leather gloves, arc-rated gloves, or rubber insulating gloves with leather protectors Hard hat Safety glasses or safety goggles Hearing protection Leather footwear

  • Arc-rated clothing with an arc rating equal to or greater than the estimated incident energy
  • Long-sleeve shirt and pants or coverall or arc flash suit
  • Arc-rated face shield and arc-rated balaclava or arc flash suit hood
  • Arc-rated outerwear (e.g., jacket, parka, rainwear, hard hat liner)
  • Heavy-duty leather gloves, arc-rated gloves, or rubber insulating gloves with leather protectors
  • Hard hat
  • Safety glasses or safety goggles
  • Hearing protection
  • Leather footwear

• The arc flash boundary shall be constructed at a distance of ___________________from exposed energized parts.

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

  Select Qualified personnel Danger tape Cone/stanchions Ladders

  • Qualified personnel
  • Danger tape
  • Cone/stanchions
  • Ladders

• Access to work site

  Select Ladder Scaffolding Roof Tunnel or pit Suspended ceiling Readily accessible

  • Ladder
  • Scaffolding
  • Roof
  • Tunnel or pit
  • Suspended ceiling
  • Readily accessible

• Potential Hazards

  Select Heat/Cold stress Electrical: damp/wet Confined Space Fall hazard Overhead hazard Fire hazard

  • Heat/Cold stress
  • Electrical: damp/wet
  • Confined Space
  • Fall hazard
  • Overhead hazard
  • Fire hazard

• Describe potential human error and mitigation methods for each potential hazard selected.

Part 4: Job work plan and briefing

• Describe the safe work practices to be employed

• Emergency response site communications

  Select Cell phone Land line/premise phone system Radio

  • Cell phone
  • Land line/premise phone system
  • Radio

• Prepare for emergency. Select all that apply as yes.

  Select Is the standby person CPR/AED trained? Is an AED available? Is the required emergency equipment available? Where is it? Plan to shut off equipment/circuit in emergency? Is there a fire extinguisher available? Are the emergency telephone numbers known?

  • Is the standby person CPR/AED trained?
  • Is an AED available?
  • Is the required emergency equipment available? Where is it?
  • Plan to shut off equipment/circuit in emergency?
  • Is there a fire extinguisher available?
  • Are the emergency telephone numbers known?

• Provide details for above checklist

Part 3 Approval(s) to perform the work while electrically energized

• Electrically Qualified Person #1

• Electrically Qualified Person #1

  Sign

• Date

  Date

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

  Yes

  No

• Speak to the requester about the possibility of not working energized, or not performing the work. DO NOT do the above work unless you understand the hazards and are comfortable .

• Evidence of completion of a job briefing, including discussion of any job-related hazards

• Electrically Qualified Person #2

• Electrically Qualified Person #2

  Sign

• Date

  Date

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

  Yes

  No

• Speak to the requester about the possibility of not working energized, or not performing the work. DO NOT do the above work unless you understand the hazards and are comfortable

• Evidence of completion of a job briefing, including discussion of any job-related hazards

• Project Manager

• Project Manager

  Sign

• Select date

  Date

• Do you agree with the justification for energized work?

  Yes

  No

• ENERGIZED ELECTRICAL WORK SHALL NOT PERFORMED. VIOLATION SHALL RESULT IN DISCIPLINE UP TO TERMINATION.

• Safety Director

• Safety Director

  Sign

• Select date

  Date

• Do you agree with the justification for energized work?

  Yes

  No

• ENERGIZED ELECTRICAL WORK SHALL NOT PERFORMED. VIOLATION SHALL RESULT IN DISCIPLINE UP TO TERMINATION.

• Do you believe the work can be done safely?

  Yes

  No

• ENERGIZED ELECTRICAL WORK SHALL NOT PERFORMED. VIOLATION SHALL RESULT IN DISCIPLINE UP TO TERMINATION.

• Host Employer - Owners Accountable Representative

• Select date

  Date

• Host employer responsibilities:
  Communicate known hazards covered by NFPA 70E are communicated to contract employer and electrical worker(s)
  
  Information about the employer’s installation that the contract employer needs to make the assessments required.
  
  Provide the contractor employer with the host’s electrical safety-related rules.
  

• Owners Accountable Representative . Owner representative understands the responsibilities and liabilities as the host employer and owner of energized equipment. The owner understands and agrees to the justification for energized electrical work per this permit.

  Sign

• Conduct job briefing
  Proceed strictly with work plan and Energized Electrical Work Permit
  Cease all work if conditions changes

• ENERGIZED ELECTRICAL WORK SHALL NOT PERFORMED. VIOLATION SHALL RESULT IN DISCIPLINE UP TO TERMINATION.