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⚡ NFPA 70E Compliant
Energized Electrical Work Permit
Arc Flash & Shock Hazard Protection
⚠️
DANGER:
Working on or near energized electrical equipment can result in serious injury or death from electric shock or arc flash. De-energize equipment when possible.
📝 New Permit
✅ Close Out Permit
📋
Permit Information
District / Base
*
Select District / Base...
Unit TBD
Other
Date
*
Start Time
*
End Time
*
Equipment/System
*
Equipment ID/Tag
Work Location
*
👥
Personnel
Qualified Electrical Person
*
Additional Workers
Work Description
*
⚡
Electrical Parameters
Voltage Class
*
Select...
50V or less
51V - 240V
241V - 480V
481V - 600V
601V - 1000V
Over 1000V
System Voltage
*
Available Fault Current (kA)
Type of Work
*
Select...
Testing/Troubleshooting
Voltage Measurement
Thermography
Visual Inspection
Racking In/Out Breakers
Removing/Installing Covers
Other
📝
Justification for Energized Work
Why can't equipment be de-energized?
*
Select justification...
Increased hazard from de-energizing
Infeasible to de-energize
Voltage testing required
Process cannot be shut down
Other (explain below)
Additional Details
⚠️
Hazard Analysis
Arc Flash Boundary (ft)
Shock Hazard Present?
*
Select...
Yes
No
Limited Approach Boundary
Restricted Approach Boundary
PPE Category Required
*
Select...
Category 1 (4 cal/cm²)
Category 2 (8 cal/cm²)
Category 3 (25 cal/cm²)
Category 4 (40 cal/cm²)
🦺
PPE Requirements
Arc-Rated Face Shield
--
Yes
No
N/A
Arc-Rated Hood/Balaclava
--
Yes
No
N/A
Safety Glasses (under shield)
--
Yes
No
Arc-Rated Suit/Coveralls
--
Yes
No
N/A
Arc-Rated Gloves
--
Yes
No
N/A
Voltage-Rated Gloves
--
Yes
No
N/A
Leather Protectors (over rubber)
--
Yes
No
N/A
Arc-Rated Hard Hat
--
Yes
No
Safety Footwear (dielectric)
--
Yes
No
🛡️
Safety Controls
Barriers/Barricades Installed?
--
Yes
No
N/A
Warning Signs Posted?
--
Yes
No
Rubber Insulating Mats?
--
Yes
No
N/A
Insulated Tools Required?
--
Yes
No
Second Qualified Person Present?
--
Yes
No
Rescue Equipment Available?
--
Yes
No
Emergency Contact Notified?
--
Yes
No
✍️
Authorization Signatures
Qualified Person Signature
*
Supervisor Signature
*
⚡ Issue Energized Electrical Work Permit
AnthroSafe™ Field Driven Safety
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