TF SAFE CMMS - New Hazard Analysis Document

Arc Flash Boundaries Reference

Voltage (phase to phase)	Category	Required PPE
Less than 240 Volts	CAT I	Long sleeve shirt, or coat and pants/coveralls. Wrap-around face shield or a comparable arc flash suit hood. Arc-rated jackets, rainwear and hard hat
241 to 600 Volts	CAT II	Long sleeve shirt, or coat and pants/coveralls. Wrap-around face shield or a comparable arc flash suit hood and sock hood/balaclava. Arc-rated jackets, rainwear and hard hat. Protective eyewear, gloves, hearing protection and leather shoes/boots.

Date:

Team Number:

Building Number:

Work Location:

Shock Hazards (select all that apply):

	Exposed energized conductors
	Equipment not properly grounded
	Damaged insulation
	Wet conditions

Other Shock Hazards:

Arc Flash Hazards (select all that apply):

	Working on energized equipment
	Opening/closing disconnects
	Testing energized circuits
	Working inside energized panels

Other Arc Flash Hazards:

Assessed Safe Plan of Action from all parties?	Yes	No
Is it safe to proceed?	Yes	No

If No, explain:

Shock & Arc Flash Risk Boundaries set?	Yes	No

Voltage Range:

Limited Approach:

Restricted Approach:

Arc Flash Boundary:

PPE Category:

Implementation of Controls Successful?	Yes	No

Note: For systems 600V or less, Flash Protection Boundary is minimum 4 feet. Engineering analysis required for systems above 600V.

Qualified Electrician:

Date: