Energized Work Permit

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Permit Information

EEWIP-20260617-001
17-JUN-2026
Team 128
H-5 (Jordan)
Hangar-RM-2-
Inspection
Mission critical equipment.

Shock Hazard Analysis

120/208V
Receptacle inspection
Exposed energized conductors
00
Avoid Contact

Flash Hazard Analysis

120/208V
4 cal/cm²
4 ft min
8 cal/cm²
CAT 0

Lock Out Tag Out

Energy Sources IdentifiedYes
PPE CAT II DonnedNo
Personnel NotifiedYes
Equipment ShutdownNo
Electrically Safe ConditionYes

LOTO Signatures

N/A
17-JUN-2026
N/A
17-JUN-2026
electrical
N/A
N/A

Completion

Inspection CompletedYes
Reenergization NotifiedNo
Isolating Devices RemovedNo
Equipment ReenergizedYes
Brett Smithson
17-JUN-2026

Review Information

Approved
17-JUN-2026