Electrical Safety Checklist
Checklist Information
Team
Pre-Work Safety Checklist
| Electrical Work Order Obtained | Yes |
| Proper Permits Issued | Yes |
| Lockout/Tagout Procedures Properly Implemented | No |
| Equipment De-energized | No |
| Safe Plan of Action (SPA) Complete | Yes |
| Task Safety Awareness (TSA) Meeting Conducted | Yes |
| Proper Personal Protective Equipment On Site | Yes |
On-Site Safety Checklist
| Notified all potentially affected personnel? | Yes |
| Hand tools in good and safe condition? | Yes |
| Ladders safe and in good condition? | Yes |
| Testing equipment in good condition? | Yes |
| All applicable AHA's correct and suitable? | Yes |
| ALL PPE in good condition and suitable? | Yes |
Explanation for 'No' Answers
Unable to isolate power supply because of mission critical equipment.
Live Work Required
YES - Additional HECP documentation required
Required HECP Documents:
Safe Plan of Action
Before beginning task, a general walk through is performed to identify obvious hazards. Hazard analysis performed/team aware of hazard results & emergency shut offs. Collective review with team of any hazards present. Each member has emergency contact & location info readily available in case of emergency. Personnel present will be notified of tasking and asked to vacate outside limited approach. All PPE/equipment checks are performed, boundaries and sentry in place.
Certification
This is to certify that we have reviewed the electrical work as described above and authorize this work to be performed. I further certify that all required safety precautions have been taken to safeguard the employees involved.
Review Information
Status History
1
| Date | From | To | Changed By | Notes |
|---|---|---|---|---|
| 16-JUN-2026 | Submitted | Approved | Greg Beveridge |