Energized Electrical JHA/JSA" HOT WORK" (ABOVE 60V)

Energized Electrical JHA/JSA" HOT WORK" (ABOVE 60V)

Complete this form every time you do hot work on a site.
Under NFPA 70E, there are only two instances in which an employee can work on live parts. In these situations, a work permit must be completed and approved by an authorized person.

1. When de-energizing would interrupt essential life support, emergency alarms or ventilation systems.

2. When the organization can demonstrate that de-energizing the system would introduce additional or increased hazards or that it is infeasible due to equipment design or operational limitations.
Lead on site*
Person filling out form*
Date*

MonthDayYear
Date
Job Name as it appears in T sheets*
Vendor/Subcontractor/Visitors*
Description of circuit/equipment/job location*
Description of work to be done*
Justification of why the circuit/equipment can not be de-energized, or the work deferred until the next scheduled outage*
Description of the safe work practices to be employed*
Has a "shock hazard" analysis been completed?*

YesNo
Has a "flash hazard" analysis been completed?*

YesNo
Are you equipped with proper PPE, to perform the assigned task? (Arc flash gear)*

YesNo
Have you restricted the potential access of an unqualified person, from entering the work zone?*

YesNo
Have you completed a job briefing, which includes the discussion of any job-related hazards?*

YesNo
Do you agree that the above described work can be done safely?*

YesNo
Are you using proper PPE? (check all that apply)*

High VisibilityHard HatGlovesSafety GlassesEarplugs
Is the site specific safety/emergency plan in place, including the nearest Urgent Care location?*

YesNo
Is the nearest fire extinguishers location known by all on site?*

YesNo
Is the location of the first aid kit known by all onsite?*

YesNo
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