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Purdue University Electrical Work Hazard Assessment and Energized Electrical Work Permit. Electrical Safety Program forms 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Job/Work Order Number and Job Location/Circuit/Equipment at the top of the form.
- Answer question 1 regarding exposure to energized electrical conductors by selecting 'Yes' or 'No'.
- For the Shock Hazard Analysis, indicate the voltage level and approach boundaries for your specific task.
- Complete the Arc Flash Hazard section by confirming if an analysis has been performed and providing necessary details if applicable.
- If equipment cannot be de-energized, proceed to complete the Energized Electrical Work Permit on page 2.
- Identify any non-electrical hazards present in your work environment by checking all that apply.
- List personal protective equipment (PPE) and safety measures you will utilize during the task.
- Finally, ensure all required signatures are obtained from employees and supervisors before submission.
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Related links
Electrical Safe Work Practices Include: Use barriers and guards to prevent passage through areas of exposed energized equipment; Pre-plan work, post hazardRead more
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