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First Time Energization Permit
Submit permit details for manager review before first time energization work.
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Privacy notice: information submitted here is used for energization permit coordination, manager review, and recordkeeping. It may be viewed by authorized managers and admins.
Job
Select Job
AWS 69 - C25012
CSB - C25020
Date/Time of Operation
Company Performing Operation
Location of Operation
Qualified Electrician In Charge of Operation
Qualified Electrician Phone Number
Safety Watch/Qualified Person
Safety Watch Phone Number
Number to Call in Case of Emergency
Location of Energy Source Controls
Circuit/Equipment and Scope of Work
Description of Work Including Individual Tasks
Has the LOTO Permit Been Completed?
Select
Yes
No
N/A
NFPA 70E Training Certificate on File?
Select
Yes
No
N/A
Equipment Clean, Free of Debris and Defect?
Select
Yes
No
N/A
QA/QC Inspection Conducted and Documentation Submitted?
Select
Yes
No
N/A
Pre-Energization Inspection Checklist Completed?
Select
Yes
No
N/A
Who Conducted and Submitted QA/QC Tests and Paperwork?
Testing Devices Used
N/A
Shock Risk Assessment Required?
Select
Yes
No
N/A
Shock Risk Assessment Completed?
Select
Yes
No
N/A
Shock Risk Without Cover
Limited Approach
Restricted Approach
Arc Flash Risk Assessment Required?
Select
Yes
No
N/A
Arc Flash Risk Assessment Completed?
Select
Yes
No
N/A
Incident Energy at Working Distance
Minimum Arc Rating
Arc Flash Boundary
Required PPE
N/A
Hard Hat
Safety Glasses
Goggles/Face Shield
Standard Gloves
Hearing Protection
Fall Protection
High Voltage Gloves
High Voltage Sleeves
High Voltage Blankets
Flash Suit
Insulated Electrical Rescue Hook
Other
Safe Work Practices
N/A
Daily Pre-Task Safety Analysis completed and job briefing discussed
Notification and communication made to all involved
Emergency plans developed and briefed
Controlled access zone in place
Warning lines installed
Handling tools/conduit discussed
Minimum approach distances discussed
Safety rigging/cable pulling discussed
Remove conductive apparel
Inspect electrical equipment for defects
Adequate lighting of work area
Inspect tools and PPE for defects
Weather conditions discussed
Manufacturer covers installed
Minimum 2 qualified persons if 480V or greater
Lock Out Tag Out Applied
Who Has Been Notified?
N/A
Method of Restriction / Warning Line Distance
N/A
Other Safe Work Practices
N/A
Can the Described Work Be Done Safely?
Select
Yes
No
N/A
If No, Explain Why
N/A
SUB Electric Qualified Person 1
SUB Electric Qualified Person 2
Method of Procedure (MOP) Document
Required: attach the Method of Procedure for this energization (PDF or Word, up to 20 MB). Permits cannot be submitted without one.
Pictures
Optional: add up to 6 pictures. Each picture can be up to 5 MB.
Submit Permit
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