Project: BLUE @ BIIP, HIDD (ARLA FOODS) Date:

(Safety Department) Rev:01

Page:01 of 01

Permit Ref. No.:- Valid Up to:

Date: Time:
(Date & Time)

ELECTRICAL WORK PERMIT

Location:
Date:
Company Name: Job No.:
Job Description (describes activities to be performed, including components
involved or voltages):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Work on energized electrical equipment is justified because de-energizing:( tick if applicable)

Introduces additional hazards Introduces increased hazards
Is infeasible due to equipment design Is infeasible due to operational limitations
Safe Work requirements
Safety Lock and Caution Notice system being followed.
Qualified personnel are assigned to perform work
First Aider available.
A standby person, equipped with insulating equipment needed for emergency response is provided
Adequate working clearance are available
Communications are available and in operating condition
The work area has adequate lighting
Work area control measures include
Barriers and signs
Attendant
Conductive items are removed (such as metal rings, watches, jewelry, buckles, badge holders)
Equipment has been de-energized and isolated to the extent feasible
Insulating protective equipment to be used:
Voltage-rated insulated tools are provided
Testing equipment at the work site is compatible with voltage present
Other: ______________________________________________________________________________

Personal Protective Equipment

Non Conductive head protection Insulated rubber gloves protectors
Safety glasses Safety Shoe
Arc blast face shield Safety Reflecting Jacket
Non-conductive clothing Other: _________________________

Signature Date

Permit Issuing Engineer

Name of Contractor/person carrying out job

Safety Officer