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Run: NFPA 70E Energized Electrical Work Permit

NFPA 70E Energized Electrical Work Permit template for documenting why energized work is required, the hazard analysis, PPE, and approvals before work begins.

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Work Request Details

Work Order Number (required)

Internal work order or maintenance ticket reference.

Request Date (required)

Date the permit request is submitted.

Work Location (required)

Specific room, area, plant, or site location where the work will occur.

Is energized electrical work required? (required)

Select yes only if the task cannot be performed de-energized.

Type of Work (required)

Select all activities that apply.

Equipment and Circuit Information

Equipment Description (required)

Describe the equipment or circuit involved, including panel, switchgear, motor control center, or other asset.

Equipment ID / Asset Tag

Optional asset identifier if available.

Nominal Voltage (V) (required)

Enter the nominal system voltage in volts.

Equipment Condition (required)

Select the current operating condition of the equipment.

Single-line diagram available? (required)

Indicate whether an up-to-date single-line diagram is available for the equipment.

Justification and De-Energization Review

Justification for Energized Work (required)

Explain why the task must be performed energized and why de-energizing is not practical, feasible, or would create additional hazards.

Was de-energization attempted or evaluated? (required)

Confirm whether lockout/tagout or other de-energization options were evaluated.

De-Energization Barriers or Constraints

Select all reasons that apply if the equipment cannot be de-energized.

Alternate Risk Controls (required)

Describe any alternate controls used to reduce risk, such as barriers, remote operation, or restricted access.

Shock and Arc Flash Analysis

Shock hazard analysis completed? (required)

Confirm that a shock risk assessment has been completed.

Arc flash analysis completed? (required)

Confirm that an arc flash risk assessment has been completed.

Incident Energy (cal/cm²)

Enter the calculated incident energy at the working distance, if available.

Arc Flash Boundary (ft)

Enter the arc flash boundary distance in feet.

Limited Approach Boundary (ft)

Enter the limited approach boundary in feet.

Restricted Approach Boundary (ft)

Enter the restricted approach boundary in feet.

PPE and Work Controls

PPE Category (required)

Select the arc-rated PPE category or equivalent work method used for this task.

Arc-Rated Clothing Required

Check if arc-rated clothing is required for this task.

Yes No N/A

Insulated Tools Required

Check if insulated tools are required.

Yes No N/A

Voltage-Rated Gloves Required

Check if voltage-rated gloves are required.

Yes No N/A

Additional PPE or Protective Equipment

List any additional PPE, face protection, hearing protection, or insulating equipment required.

Personnel, Authorization, and Acknowledgment

Qualified Worker Name (required)

Name of the qualified person performing the work.

Supervisor / Approver Name (required)

Name of the supervisor or authorized approver.

Safety review completed? (required)

Confirm that the electrical safety review has been completed before work starts.

Worker Signature (required)

Signature confirming the worker understands the hazards and controls.

Approver Signature (required)

Signature confirming authorization to proceed with energized work.

Consent to collect and store submission details (required)

By submitting this permit, you consent to the collection and storage of the information provided for safety, compliance, and audit trail purposes. Do not include unnecessary PII.

Yes No N/A

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