NFPA 70E Energized Electrical Work Permit

Permit form for documenting and approving energized electrical work under NFPA 70E, including justification, shock and arc flash risk assessment, PPE, controls, and authorization.

Permit Details

• Permit title
• Work order or ticket number
• Facility / site location
• Permit date
• Planned work start time
• Planned work end time

Energized Work Justification

• Equipment / circuit description
• Nominal voltage level
• Description of energized work
• Why de-energization is not feasible
• Type of energized work
• Describe other work type

Shock and Arc Flash Risk Assessment

• Shock hazard present?
• Arc flash hazard present?
• Incident energy value
  Enter the calculated incident energy if available.
• Incident energy units
• Limited approach boundary distance
  Enter the applicable boundary distance and units if used in the job plan.
• Risk controls to be used
• Describe other risk controls

PPE and Work Controls

• PPE required
• Describe other PPE
• Pre-job briefing completed?
• Lockout/tagout alternatives reviewed?
• Additional controls / work instructions

Personnel and Qualifications

• Requestor name
• Qualified worker / lead electrician
• Crew size
• All workers are qualified for the task?
• Supervisor / manager name

Approvals and Acknowledgment

• Safety review required?
• Approver name
• Approval date
• Permit authorized for energized work
  Check only when all required controls, PPE, and approvals are complete.
• Worker acknowledgment
  I understand the hazards, controls, and stop-work expectations for this permit.