Title Page
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Site conducted
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Date and Time
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Task
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Work location
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Conducted on
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Prepared by
Access Control
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1. Is the “proximity/vicinity permit” being followed when working next to live HV Equipment
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2. Are the electrical cabinet panels/doors clear and accessible?
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3. Are controls in place to keep unauthorised people out of the work area?
Isolation and Verification of Zero Energy
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4. Is an approved isolation procedure being followed?
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5. Are all personal locks on the correct isolation point?
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6. Has the electrical isolation been verified by testing for the absence of voltage? E.g. using a multimeter or approved device.
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7. Has the test instrument been checked on a known 'live' source before<br>and after the test for the absence of voltage?
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8. Has the team confirmed there is no risk of inadvertent contact with<br>exposed live parts within the work area?
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9. For un-isolated work (including testing and fault finding), is an approved<br>procedure being followed?
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10. Have all energy sources been identified, isolated and checked for zero<br>energy?
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11. Are all isolation points identified clearly?
Electrical PPE
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12. Is the correct Arc Flash rated PPE to work in this location being worn<br>e.g. CAT 0, 1, 2 or 4?
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13. Is all electrical PPE in good condition and safe for use? e.g. free from<br>damage and contaminants (such as water, grease and oil)
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14. If voltage rated gloves are being used, are they within their test date<br>and appropriate for the task i.e. rated?
Electrical Protection
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15. Are the most recent single line and electrical drawings being used?
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16. Has the team verified the portable earthing equipment in use is<br>properly connected and tested?
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17. When using plug in electrical equipment, are all socket outlets protected<br>by appropriate earth leakage protection e.g. Residual Current Devices<br>(RCDs)?
Non-Conductive Tools and Equipment
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18. Are the tools and equipment being used adequate for the task? i.e.<br>appropriate voltage rating, free from defects, unmodified
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