Energized Electrical Work Permit Request

Under NFPA 70E, there are only two instances in which an employee can work on live parts. In these situations, a work permit must be completed and approved by an authorized person.

When de-energizing would interrupt essential life support, emergency alarms or ventilation systems.
When the organization can demonstrate that de-energizing the system would introduce additional or increased hazards or that it is infeasible due to equipment design or operational limitations.

The permit must be posted in an appropriate and obvious location where the energized work is taking place for the duration of the task.

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Part 1 - Work Request

Work Site location:* Required

Work order/project number:* Required

Planned start date/time:* Required

Planned end date/time:* Required

Description of the work to be performed:* Required

Equipment requested to be shut down:* Required

Requested by:* Required

Part 2 - Shock Analysis/Approach boundaries

Limited approach boundary* Required

Restricted approach boundary* Required

Prohibited approach boundary* Required

Part 3 - Arc Flash Hazard Analysis

Arc Flash Protection Boundary* Required

Hazard Category for Task* Required

ATPV Rating for FR Clothing* Required

Part 5 - Justification for the live work request:

Shut down creates an increased/additional hazard (specify):* Required

Shut down is "not" feasible due to design or operational limitations (specify):* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files