Work Information

Team Members

Pre-Work Safety Checklist

QuestionYesNo
Electrical Work Order Obtained
Proper Permits Issued
Lockout/Tagout Procedures Properly Implemented
Equipment De-energized
Safe Plan of Action (SPA) Complete & entered below
Task Safety Awareness (TSA) Meeting Conducted
Proper Personal Protective Equipment On Site

On-Site Safety Checklist

After arrival at your work location, have you:

QuestionYesNo
Notified all potentially affected personnel?
Checked that hand tools to be used are in good and safe condition?
Checked that ladders, if required, are safe to use and in good condition?
Checked any and all testing equipment and associated leads are in good condition and safe to use?
Confirmed all applicable AHA's are correct and suitable for the task?
Checked that ALL PPE is in good condition and suitable for use?

Explanation for 'No' Answers

If any questions above were answered 'No', provide explanation:

Live Work Requirement

Note: If live work is required, additional HECP documentation (Hazard Analysis Documentation and Energized Electrical Work Permit) must be completed before work begins.

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.

Safe Plan of Action