Purdue University Electrical Work Hazard Assessment and Energized Electrical Work Permit. Electrical Safety Program forms 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Job/Work Order Number and Job Location/Circuit/Equipment at the top of the form.
3. Answer question 1 regarding exposure to energized electrical conductors by selecting 'Yes' or 'No'.
4. For the Shock Hazard Analysis, indicate the voltage level and approach boundaries for your specific task.
5. Complete the Arc Flash Hazard section by confirming if an analysis has been performed and providing necessary details if applicable.
6. If equipment cannot be de-energized, proceed to complete the Energized Electrical Work Permit on page 2.
7. Identify any non-electrical hazards present in your work environment by checking all that apply.
8. List personal protective equipment (PPE) and safety measures you will utilize during the task.
9. Finally, ensure all required signatures are obtained from employees and supervisors before submission.

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