Professional Documents
Culture Documents
Testing, Troubleshooting, and Voltage Measuring Electrical Work Permit Department Code: HP Permit # HP - 003
Testing, Troubleshooting, and Voltage Measuring Electrical Work Permit Department Code: HP Permit # HP - 003
Department Code: HP
Permit # HP -003
PART I: TO BE COMPLETED BY THE REQUESTER:
(1)
Description of circuit/equipment/job location: __Power Panel SS-4, breaker 4/ 480 V heat pump/ Building 348_High Bay_
(2)
Description of work to be done: _____Remove existing heat pump and replace with Carrier type___
(3)
Justification of why the circuit/equipment cannot be de-energized or the work deferred until the next scheduled outage:
__High Bay requires temperature range of 68 deg to 74 deg
_______________
(2)
(3)
LOTO
Reason not to LOTO ____Calibration source requires
Description of the Safe Work Practices to be employed:
stable temperature.
_____________________________________________________________________________________________________
Flash Boundary
Shock Hazard
4
480V
Flash Hazard
Limited Approach
Restricted Approach
Prohibited Approach
4
3-6
1-0
0-6
Working Distance
Glove Class
4
0
(4)
Protective Equipment
None
Earplugs
Leather Gloves
Leather Shoes
Cotton Clothing
Face shield
Voltage-rated Gloves
Voltage-rated Shoes
Fr Clothing
Flash suit
Hard Hat
Safety Glasses/Goggles
_____________________________________________________________________________________________________
(5)
Means employed to restrict the access of unqualified persons from the work area: ______caution tape_____
______________________________________________________________________________________________________
_____2-30-07______
Date
_______Smart Guy____________________________
Electrically Knowledgeable Person/Lead Engineer
_______2-31-07________
Date
________Des Jockey____________________
Chief Engineer/Delegate
______2-32-07________
Date
Name
_________________________
Life #
______
Name
_______________________
Life #
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
______
_______________________
______
_________________________
___________
Authorizing Supervisor
Date
Supervisor acknowledges the above personnel are properly trained, knowledgeable and experienced to work under the permit.
Forward a copy to group's safety department.
1.1/19204e021.doc
(02/2007)