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Run: NFPA 70E Energized Electrical Work Permit

This NFPA 70E Energized Electrical Work Permit template documents why energized work is necessary, the hazards present, the PPE required, and who authorized ...

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Permit Details

Permit title (required)

Work order or ticket number (required)

Facility / site location (required)

Permit date (required)

Planned work start time (required)

Planned work end time (required)

Energized Work Justification

Equipment / circuit description (required)

Nominal voltage level (required)

Description of energized work (required)

Why de-energization is not feasible (required)

Type of energized work (required)

Describe other work type (required)

Shock and Arc Flash Risk Assessment

Shock hazard present? (required)

Arc flash hazard present? (required)

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 (required)

Describe other risk controls (required)

PPE and Work Controls

PPE required (required)

Describe other PPE (required)

Pre-job briefing completed? (required)

Lockout/tagout alternatives reviewed? (required)

Additional controls / work instructions

Personnel and Qualifications

Requestor name (required)

Qualified worker / lead electrician (required)

Crew size (required)

All workers are qualified for the task? (required)

Supervisor / manager name (required)

Approvals and Acknowledgment

Safety review required? (required)

Approver name (required)

Approval date (required)

Permit authorized for energized work (required)

Check only when all required controls, PPE, and approvals are complete.

Yes No N/A

Worker acknowledgment (required)

I understand the hazards, controls, and stop-work expectations for this permit.

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