P&S Job Site Safety Inspection

Supervisor*

Chris Pettis Projects*

Cody Zimmerman Projects*

Eric O' Donel Projects*

Joe Perez Projects*

Josh DiGulio Projects*

Kris Gardner Projects*

Paul Schaider Projects*

Sean Sesher Projects*

Zach McCoy Projects*

Other Project (jobs that may not appear in the drop down menu above)

Type of Hot Work*

Testing for the absence of voltageTroubleshootingWorking on (or near) energized components

Is this permit for work that is being planned for another day or is this for emergency/service work that needs to happen immediately?*

Planned (tomorrow or a later date)Emergency (today)

Date for performance of Hot Work*

Date

P&S Employees Participating in Hot Work*

Will there be Non-P&S personnel on-site, that need to be inside the Arc Flash Boundary or the Limited Approach Boundary?*

YesNo

Non-P&S Personnel Participating in Hot Work*

Why do these Non-P&S Personnel need to be involved in the Hot Work?*

Circuit Description/Location:*

Description of work to be done:*

Why the circuit cannot be de-energized and/or why can the work not be scheduled during an allowed outage:*

Detailed description of the job procedures to be used in performing the above detailed work:*

Description of the safe work practices to be employed:*

Has the equipment shutdown/de-energized?*

YesNo

What was done to shutdown/de-energize the equipment so that it is in an electrically safe work condition?*

DisconnectedLocked OutFuses RemovedOther

Nominal System Voltage Range*

Phase to Phase

Maximum Voltage Present (phase-to-phase):*

Limited Approach Boundary (Exposed Movable Conductor)	10 ft. 0 in.
Limited Approach Boundary (Exposed Fixed Part)	3 ft. 6 in.
Restricted Approach Boundary	Avoid Contact
Req'd Hot Glove Rating	0 Red (1000v rated)

Limited Approach Boundary (Exposed Movable Conductor)	10 ft. 0 in.
Limited Approach Boundary (Exposed Fixed Part)	3 ft. 6 in.
Restricted Approach Boundary	1 ft. 0 in.
Hot Glove Rating Req'd	0 Red (1000v rated)

Limited Approach Boundary (Exposed Movable Conductor)	10 ft. 0 in.
Limited Approach Boundary (Exposed Fixed Part)	5 ft. 0 in.
Restricted Approach Boundary	2 ft. 2 in.
Hot Glove Rating Req'd	2 Yellow (17,000v rated)

Limited Approach Boundary (Exposed Movable Conductor)	10 ft. 0 in.
Limited Approach Boundary (Exposed Fixed Part)	6 ft. 0 in.
Restricted Approach Boundary	2 ft. 9 in.
Hot Glove Rating Req'd	4 Orange (36,000v rated)

Equipment*

Panelboards or other equipment rated 240 volts and below.Panelboards or other equipment rated greater than 240 volts and up to 600v.600 volt class (480v) motor controls centers (MCC).600 volt class (480v) switchgear (with power circuit breakers or fused switches).Other 600v class equipment (277v-600v).NEMA E2 (fused contactor) motor starters, 2.3kv through 7.2 kV.Metal-clad switchgear, 1 kV through 15kV.Other equipment 1kv through 15kV.