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Electrical Safety Program

Work Practices for Qualified Persons

(OSHA & NFPA 70E)

Updated: February 2017

University of Northern Iowa

Electrical Safety - Work Practices Program

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TABLE OF CONTENTS

1. Purpose & Responsibilities........................................................................................................................................ 3

2. Training Requirements .............................................................................................................................................. 3

3. Test Instruments & Equipment/Accessories ............................................................................................................. 4

4. Visual Inspections ..................................................................................................................................................... 4

5. Job Briefing ............................................................................................................................................................... 5

6. Hazard / Risk Evaulation ........................................................................................................................................... 5

7. Working On or Near Electrical Conductors or Circuit Parts ..................................................................................... 5

8. Working On or Near Energized Parts (Justified for Energized Work)...................................................................... 5

9. Energerized Electrical Work Permit .......................................................................................................................... 6

10. Properly Maintained Electrical Panel .................................................................................................................... 6-7

11. Approach Boundaries to Live Parts .......................................................................................................................... 7

12. Preparation for Approach, Unqualified Person(s) .................................................................................................... 8

13. Arc Flash Risk Assessment ...................................................................................................................................... 8

14. Guarding Exposed Energized Electrical Circuit Parts .............................................................................................. 9

15. Buried or Concealed Electrical Hazards ................................................................................................................... 9

16. Personal Protective Equipment Requirements ......................................................................................................... 9

17. Personal Protective Equipment - Specific ........................................................................................................... 9-10

18. Other Protective Equipment ................................................................................................................................... 10

19. Rubber Insulated Equipment Voltage Requirements (OSHA Table)……………………………… ................... 11

APPENDIX “A” Job Briefing and Job Planning Check Sheet .................................................................................... 12

APPENDIX “B” Risk Assessment Procedure .............................................................................................................. 13

APPENDIX “C” Physical Plant Energized Electrical Work Permit ....................................................................... 14-15

APPENDIX “D” Arch Flash Field Label Example ...................................................................................................... 16

APPENDIX “E” Approach Boundaries AC Current .................................................................................................... 17

APPENDIX “F” Approach Boundaries AC Voltage ................................................................................................... 18

APPENDIX “G” Safety Acknowledgement Sheet ....................................................................................................... 19

APPENDIX “H” Tracking PPE and Equipment Inspections ....................................................................................... 20

APPENDIX “I” Arch Flash Hazard Identification table ......................................................................................... 21-23

APPENDIX J Arch Flash Hazard Identification AC Voltage …………………….. ................................................... 24

APPENDIX “K” Arch Flash Hazard Identification DC Voltage ................................................................................. 25

APPENDIX “L” Protective Clothing and Personal Protective Equipment (PPE) ....................................................... 26



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1. Purpose: The purpose of this program is to establish safe work practices and procedures for University of Northern

Iowa (UNI) Physical Plant (PHP) employees exposed to electrical hazards in the workplace.

a. Objective:

To safeguard our employees by providing an electrical safety management guide for compliance.

b. Employees Responsibility for Safety:

Before proceeding with any type of electrical work, all qualified employees shall assure themselves that they

can perform the work without injury. If they are assigned work they are not qualified to they shall call this

to their Supervisor’s attention.

c. Relationships with PHP and other Contractors:

When outside contractor personnel are engaged in electrical work at UNI facilities for Physical Plant, the

PHP Maintenance or project Supervisor in charge shall conduct a meeting with the contractors and inform

them of the following:

• Known hazards that are covered by NFPA 70E 2015 that are related to their work and that might

not be recognized by their employees.

• Information about UNI’s installation will be made available. Any assessment relating to electrical

hazards, and any existing electrical hazards from our Arc Flash Hazard

Analysis, if one was conducted.

This coordination meeting will be documented using the Physical Plant’s Safety Acknowledgement Sheet

APPENDIX “G” Page 19 of this program.

d. Physical Plant Responsibilities:

Physical Plant shall be responsible for the implementation of specific procedures and practices that meet or

exceed those contained within this program, OSHA, and NFPA 70E 2015.

2. Training Requirements: The training requirements contained in this section shall apply to all UNI qualified

employees who face a risk of electrical hazard that is not reduced to a safe level required by the National Electrical

Code installation requirements. Such qualified employees will be trained to identify and understand the relationship

between electrical hazards and possible injury.

a. Type of Training:

The training required shall be classroom, on the job, or a combination of the two. The degree of training

provided shall be determined by the employee’s risks.

b. Emergency Training:

Employees working on or near the approach boundaries as found in NFPA 70E 2015 edition, who are

exposed to energized electrical conductors or circuit parts shall as a minimum:

• Fully understand the emergency procedures for the facility at which work is being performed.

• Be trained in methods of release of victims from contact with exposed energized conductors or

circuit parts.

• Qualified employees shall be regularly (as required by American Red Cross) instructed in methods

of first aid and emergency procedures, such as approved methods of resuscitation, including

cardiopulmonary resuscitation (CPR) and the use of automated external defibrillator (AED).

Qualified employees shall be certified by the employer every two years as required by the certifying

agency.



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c. Employee Job Safety Training:

Qualified persons shall be trained and knowledgeable of the construction and operation of equipment or

specific work method, and be trained to recognize and avoid the electrical hazards that might be present with

respect to that equipment or work method. Qualified Person REF: NFPA 70E 2015 110.2 (D) (1) – A person

who is fully trained in the University’s electrical safety program, whom the University has confirmed that

they understand the program and are capable of properly following all of the requirements of the program.

The University will provide the proper PPE for their classification and they shall be deemed “Qualified” by

the University. Such qualified persons shall also be familiar with the proper use of special precautionary

techniques, PPE, insulating and shielding materials, insulated tools and test equipment as appropriate for the

task. Such qualified persons permitted to work within limited approach of exposed energized conductors

and circuit parts shall, at a minimum, be additionally trained in all of the following:

• The skills and techniques necessary to distinguish exposed energized electrical conductors and

circuit parts from other parts of electric equipment.

• The skills and techniques necessary to determine the nominal voltage of exposed energized

electrical conductors and circuit parts.

• The distances specified in the NFPA 70E 2015 Approach Boundaries to Live Parts for Shock

Protection Table 130.4(D)(a) APPENDIX “E” Page 17 and (Table 130.4(D)(b) APPENDIX “F”

Page 18 of this document.

• The decision making process necessary to determine the appropriate Personal Protective Equipment

(PPE) and job planning necessary to perform the task safely.

• Training shall include safety related work practices contained in 1926.416 and 1926.417 for

construction. 1920.331 – 1910.335 in general industry standards and information contained in the

NFPA 70E 2015 Standard for Electrical Safety in the Workplace.

d. Unqualified Person:

• REF: NFPA 70E 110.2 (D) (2) – The training of unqualified persons is not included in this program.

3. Test Instruments and Equipment/Accessories: The training requirements contained in this section shall apply to all

qualified UNI employees who face a risk of electrical hazard that is not reduced to a safe level required by the National

Electrical Code installation requirements. Such qualified employees will be trained to identify and understand the

relationship between electrical hazards and possible injury.

a. Shall be rated for the voltage and equipment to which they will be connected.

b. Shall be rated for the voltage and equipment to which they will be connected, designed for the environment

to which they will be exposed, and for the manner in which they will be used.

c. Shall be visually inspected for external defects and/or damage before the equipment is used on any shift

d. Calibrate per manufacturer’s requirements.

e. When test instruments are used to determine the absence of voltage on conductors or circuit parts operating

at 50 volts or more, the operation of the test instrument shall be verified before and after an absence of

voltage test is performed.

f. Test instruments, equipment or accessories found to be defective, damaged or out of Calibration, shall be

removed from service and tagged “Danger Unsafe Do Not Use”.

4. Visual Inspection of Portable Cord and Plug Connected Equipment and Flexible Cord Sets: Before each use and

at the time of any shift change, portable cord and plug-connected equipment shall be visually inspected by the

employee for external defects (such as loose parts, deformed and missing pins) and for evidence of possible internal

damage. (Such as, pinched or crushed outer jackets). Any portable cord and plug-connected equipment or flexible

cord sets found to be defective or damaged shall be removed from service and tagged, “Danger Unsafe Do Not Use” or

cord cap shall be removed.



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5. Job Briefing:

a. The Job Briefing for routine work will require only a brief discussion if the qualified employee, by virtue of

training and experience, can reasonably be expected to recognize and avoid the hazards in the job.

b. A Job Briefing for non-routine job/tasks, will be conducted by the qualified employee in charge, and shall

include the following:

• Hazards associated with the job.

• Work procedures involved.

• Special precautions.

• Energy source controls.

• Personal Protective Equipment requirements.

Reference: APPENDIX “A” page 12 in this document, the Job Briefing and Planning Check Sheet.

c. Follow the Hazard/Risk Procedure if either of the following applies:

• The work is complicated or particularly hazardous.

• The qualified employee cannot be expected to recognize and avoid the hazards involved in the

job.

6. Hazard/Risk Evaluation Procedure: Before work is started on, or near live parts operating at 50 volts or more, each

qualified employee shall conduct a Hazard/Risk or Shock Hazard Analysis evaluation using Risk Assessment

Procedure in APPENDIX “B” page 13 of this document.

7. Working on or Near Electrical Conductors or Circuit Parts: Prior to working on or near exposed electrical

conductors and circuit parts operating at 50 volts or more, lockout/tagout (LOTO) devices shall be applied in

accordance with the University’s Energy Control Program (LOTO).

8. Working on or Near Energized Parts (Justification for Energized Work): Energized electrical conductors and

circuit parts, to which a qualified employee might be exposed, shall be put into an electrically safe work condition

before a qualified employee works within Limited Approach Boundary of those conductors or parts.

1. Greater Hazard. Energized work shall be permitted where it can demonstrated that de-energizing

introduces additional or increased hazards. Examples of increased or additional hazards include, but are not

limited to interruption of life support equipment, deactivation of emergency alarm systems, and shutdown

of hazardous location ventilation equipment.

2. Infeasibility. Energized work shall be permitted where it can be demonstrated that the task to be

performed is infeasible in a de-energized state due to equipment design or operational limitations.

Examples include performing diagnostic and testing (e.g. start-up or troubleshooting) of electric circuits

that form an integral part of a continuous process.

3. Less Than 50 Volts. Energized electrical conductors and circuit parts that operate at less than 50 volts to

ground shall not be required to be de-energized.

4. Normal Operation. Normal operation of electric equipment shall be permitted where all of the following

conditions are satisfied:

• The equipment is properly installed.

• The equipment is properly maintained.

• The equipment doors are closed and secured.

• All equipment covers are in place and secured.

• There is no evidence of impending failure.

• An example of normal operation includes, but is not limited to operating a switch rated breaker

to turn lights on and off.



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9. Energized Electrical Work Permit:

a) Working on energized electrical conductors or circuit parts that are not placed in an electrically safe work

condition (as indicated above in 8,1 or 8,2), the work performed shall be considered Energized Electrical

Work and shall be permitted by completing the University’s Energized Electrical Work Permit APPENDIX

“C” Page 14-15 in this document.

b) Exemption. An energized electrical permit shall not be required if a qualified person is provided with and

uses appropriate PPE and safe workplace practices in accordance with OSHA and NFPA 70E, Chapter 1

under any of the following conditions:

• Testing, troubleshooting, voltage measuring.

• Thermography and visual inspection if the restricted approach boundary is not crossed.

• Access to and egress from as area with energized electrical equipment if no electrical work is

performed and the restricted approach boundary is not crossed.

• General housekeeping and miscellaneous non-electrical tasks are performed if the limited

approach boundary is not crossed.

• For locations >40cal/cm2 incident energy, a qualified person shall be required to wear a

minimum 40 cal/cm2 suit provided by the University of Northern Iowa to open the enclosure,

inspect, test, and verify voltage. No work shall be permitted on such an energized circuit.

10. Properly Maintained Electrical Panel:

1) REF: NFPA 70E 2015 Chapter 2, 110.2 (D) (2) – In keeping with “industry consensus standards” a properly

maintained panel at the University of Northern Iowa shall be: properly installed, the enclosure is completely intact,

there are no open spaces or missing circuit breakers, all screws are installed and secured, there is no evidence of

impending failure, the condition of each breaker has been checked & documented with an infrared (IR) camera

when the campus Arc Flash study is updated or when changes are made to the loads on an individual panel. Such

panels are considered to be properly maintained and will be identified with a label noting the year the IR scan was

completed.

2) REF: National Electrical Manufacturers Association AB 4: “Exposed Face Temperature Check” 4.2.2 Procedure

- A properly maintained alternating current circuit breaker at the Univeristy of Northern Iowa shall be inspected

as recommended in NEMA AB 4 4.2.2, paraphrased here: With the breaker enclosed as in normal use, carrying

normal load current, and with the door (if any) giving access to the breaker operating handle open, check the

exposed accessible insulated face of the breaker and the adjacent, surrounding, dead front surfaces of the

enclosure for their approximate operating temperature. This will be done by a thermographic (IR) camera to

identify excessive temperature conditions at the surface. The results will be documented in FAMIS 4.2.3

Results: Temperature rises above ambient exceeding 35°C (95°F) on metal and 60°C (140°F) on plastic surfaces

(See UL 489 7.1.4.1.1) are considered excessive and may be an indication of overheating. Further investigation

will be as follows”. A breaker exceeding these temperatures will be tested for current flow. For breakers

exceeding 80% of its trip ampacity, the circuit will be evaluated and part of the load removed. Breakers

exceeding the temperature range with ampacities under 80% will be replaced.

Continued



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• NEMA AB 4 – Guidelines for Inspection and Preventive Maintenance of Molded Case Circuit

Breakers Used in Commercial and Industrial Applications

o Introduction: “This document is intended to ensure that molded case circuit breakers

are well maintained, and provided guidelines for circuit breaker replacement.”

o Cause 4 deals with Inspection Procedures and describes thermal checks (4.2) –

“…over heating of the circuit breaker would necessitate further investigation, and

cracks in the molded case would certainly necessitate circuit breaker replacement.”

o The last sentence in Cause 7: “This document should be used for recommended,

periotic preventive maintenance.”

o Guidelines 3.4: GUIDANCE REGARDING INSPECTION AND PREVENTIVE

MAINTENANCE PROCEDURES: Industrial users have requested guidance

regarding inspection and preventive maintenance procedures which could be carried

out on a regularly scheduled basis. Clauses 4 through 7 of this publication set forth

guidelines for inspection, preventive maintenance, and testing. These clauses may be

applied independently or in combination to establish such a program. For additional

assistance, consult the manufacturer's published instructions.

o 4.2.2 Procedure: With the breaker enclosed as in normal use, carrying normal load

current, and with the door (if any) giving access to the breaker operating handle

open, check the exposed accessible insulated face of the breaker and the adjacent,

surrounding, dead front surfaces of the enclosure for their approximate operating

temperature. This may be done by a thermographic survey or a temperature

measuring instrument to identify excessive temperature conditions at the surface.

o 4.2.3 Results: Temperature rises above ambient exceeding 35°C (95°F) on metal

and 60°C (140°F) on plastic surfaces (See UL 489 7.1.4.1.1) are considered

excessive and may be an indication of overheating. Further investigation may be

necessary.

o 5. PREVENTIVE MAINTENANCE - 5.1 GENERAL: Under normal conditions,

properly applied molded case circuit breakers require maintenance only for

verification of environmental conditions and that the correct enclosure type for those

conditions is being used.

11. Approach Boundaries to Live Parts:

a. Shock Risk Assessment: A shock risk assessment shall determine the voltage to which personnel will be

exposed, boundary requirements, and Personal Protective Equipment necessary in order to minimize the

possibility of electric shock to personnel. Refer to Approach Boundaries to Live Parts for Shock Protection

Table 130.4D(a) for AC APPENDIX “E” page 17 or 130.4D(b) for DC APPENDIX “F” Page 18.

b. Approach to Exposed Live Parts Operating at 50 Volts or More: No qualified person shall approach or take

any conductive object closer to exposed live parts, operating at 50 volts or more, than the restricted approach

boundary (as set forth in Table 130.4D(a) for AC APPENDIX “E” Page 17 or 130.4D(b) for DC

APPENDIX “F” Page 18 unless the qualified person is insulated or guarded from the live parts operating at

50 volts or more (insulated gloves or insulating gloves and sleeves are considered insulation only with

regard to the energized parts upon which work is performed), and no uninsulated part of the qualified

person’s body can come in contact with exposed energized electrical conductors or circuit parts.

c. Employees shall use properly rated insulated tools and/or handling equipment when working on exposed

energized electrical conductors or circuit parts where tools or handling equipment might make accidental

contact.



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12. Preparation for Approach, Unqualified Person(s): Observing a Safe Approach Distance for exposed energized

electrical conductors or circuit parts is an effective means of maintaining electrical safety. As the distance between a

person and exposed energized conductors or circuit parts decreases, the potential for an electrical accident increases.

a. Unqualified Persons, Safe Approach Distance. No unqualified person is permitted to approach nearer than

the Limited Approach Boundary of energized conductors or circuit parts unless permitted by section b) below.

b. Unqualified Persons Entering the Limited Approach Boundary. Where there is a need for an unqualified

person to cross the limited approach boundary, a qualified person shall advise him or her of the possible

hazards, AND continuously escort the unqualified person while inside the limited approach boundary.

Under no circumstance may an unqualified person cross the Restricted Approach Boundary

Limits of Approach Graphic

13. Arc Flash Risk Assessment: Physical Plant employees shall refer to the existing “ARC Flash Hazard Analysis”

assessment to determine if arc flash hazards exist. The results of this analysis are indicated by a “Field Label” affixed to

the electrical equipment APPENDIX “D” Page 16. Physical Plant employees will utilize the facility “Arc Flash Hazard

Analysis”.

In absence of a recognized analysis, refer to NFPA 70E (2015) Arc-Flash Hazard Identification Table

130.7(C)(15)(A)(a) APPENDIX “I” Pages 21-23, Arc-Flash Hazard PPE Categories for Alternating Current,

Table 130.7(C)(15)(A)(b) APPENDIX “J” Page 24, Arc-Flash Hazard PPE Categories for Direct Current,

Table 130.7(C)(15)(B) APPENDIX “K” Page 25, Personal Protective Equipment (PPE), Table 130.7(C)(16)

APPENDIX “L” Pages 26 in this document to determine the Arc-Flash Boundary, Arc-Flash PPE Category and

the personnel protective equipment to be used.



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14. Guarding Exposed Energized Electrical Circuit Parts:

a. Barricades shall be used in conjunction with safety signs where it is necessary to prevent or limit employee

access to work areas containing energized conductors or circuit parts. When needed, PHP employees shall

place barriers of red “Danger” tape in conjunction with safety signs to prevent or limit unqualified persons

access to the electrical hazard. Place the barriers no closer than the limited approach boundary given in

NFPA 70E 2015 Table 130.4 (D)(a) APPENDIX “E” Page 17 and 130.4 (D)(b) APPENDIX “F” Page 18 in

this document.

b. If signs and barriers do not provide sufficient warning or students and faculty are at risk because of the

location of energized conductors, an attendant shall be stationed to warn and protect persons.

15. Buried or Concealed Electrical Hazards:

a. Before excavation starts where there exists a reasonable possibility of contacting electrical lines or equipment,

the employer shall take the necessary steps to contact the appropriate owners or authorities to identify and

mark the location of the electrical lines or equipment. When it has been determined that a reasonable

possibility of contacting electrical lines or equipment exists, appropriate safe work practices and PPE shall be

used during the excavation.

b. Before cutting or drilling into equipment, floors, walls, or structural elements where a likelihood of contacting

energized electrical lines or parts exists, the employer shall perform a risk assessment to:

• Identify and mark the location of conductors, cables, raceways, or equipment

• Create an electrically safe work condition

• Identify safe work practices and PPE to be used

16. Personal Protective Equipment Requirements – General:

a. General. Employees working in areas where electrical hazards are present shall use:

• Protective equipment that is designed and constructed for the specific part of the body to be

protected and for the work to be performed. See APPENDIX “L” Pages 26 in this document for

PPE.

• Properly maintained electrical panels identified with less than 4 cla/cm2 incident energy. The

proper PPE to operate a breaker shall be: intact leather glove and FR sleeve rated 4 cal/cm2 or

greater.

b. Care of Equipment. Protective equipment shall be maintained in a safe, reliable condition.

• The protective equipment shall be visually inspected before each use.

17. Personal Protective Equipment – Specific:

a. General: When an employee is working within the Arc Flash Boundary, he/she shall wear protective

clothing and other personal protective equipment as required by our Arc Flash Hazard Analysis or in

accordance with Table 130.7(C) (16) APPENDIX “L” Pages 26 in this document.

b. Movement and Visibility. When flame-resistant (FR) clothing is worn to protect and employee, it shall

allow for movement and visibility. Clothing made from flammable synthetic materials that melt, such as

nylon, polyester polypropylene and spandex may not be use.

c. Head, Face, Neck and Chin Protection. Employees shall wear nonconductive head protection wherever

there is a danger of head injury from electric shock or burns due to contact with live parts or from flying

objects resulting from electrical explosion. Employees shall wear nonconductive protective equipment for

the face, neck and chin whenever there is a danger of injury from exposure to electric arcs or flashes; or from

flying objects resulting from electrical explosion. Hard hats shall meet current ANSI Z89.1, Class E & G.

d. Balaclava. Where necessary, employees shall wear FR Balaclava. To eliminate potential transmission of

cold and flu viruses, it is recommended that employees not share a balaclava.



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e. Eye Protection. Employees shall wear protective equipment for the eyes whenever there is a danger of

injury from electric arcs, flashes, or from flying objects resulting from electrical explosion. Safety glasses

shall meet current ANSI Z87 and have non-metallic frames.

f. Body Protection. Employees shall wear FR clothing wherever there is possible exposure to an electric arc

flash hazard.

g. Care and Maintenance of FR Clothing and FR Flash Suits:

• Inspection: FR apparel shall be inspected before each use. Work clothing or flash suits that are

contaminated, or damaged to the extent their protective qualities are impaired shall not be used.

Protective items that become contaminated with grease, oil, or flammable liquids or combustible

materials shall not be used.

• Care: All FR clothing shall be laundered per each manufacturer’s instructions.

h. Hand and Arm Protection. Employees shall wear rubber gloves with leather protectors where there is a

danger of hand and arm injury from electric shock due to contact with live parts. Hand and arm protection

shall be worn where there is possible exposure to arc flash burn.

• Insulating Gloves – Per Use/Periodic Testing: Per use testing of rubber insulated gloves shall be

done by inflating them. All rubber insulating gloves shall be voltage tested by a qualified testing

facility before they are first issued and every 6 months thereafter. PHP is responsible to determine

a testing facility and establish a tracking system to ensure this requirement is met. A competent

qualified person may be designated to track insulating glove inspections.

i. Foot Protection. Footwear shall meet the current ASTM F2413 standard and shall have non-metallic

composite toes and for electrical hazard.

18. Other Protective Equipment: (See also OSHA CFR 1910.137)

a. Insulated Tools and Equipment. Employees shall be issued and use electrically insulated tools and/or handling

equipment when working inside the Limited Approach Boundary of exposed live parts where tools or handling

equipment might make accidental contact.

b. Requirements for Electrically Insulated Tools. The following requirements shall apply to insulated tools:

• Insulated tools shall be rated for the voltage on which they are used.

• Insulated tools shall be designed and constructed for the environment to which they are exposed and the

manner in which they are used.

c. Fuse Pulling Equipment. Fuse pullers shall be rated for the circuit voltage.

NEVER REMOVE A FUSE UNDER LOAD!

d. Ropes and Hand lines. Ropes and hand lines used near exposed live parts operating at 50 volts or more, or used

where an electrical hazard exists, shall be nonconductive.

e. Fiberglass-Reinforced Plastic Rods (hot stick). Fiberglass reinforced plastic rod and tube used for live-line

tools shall meet the requirements of applicable portions of electrical codes and standards dealing with electrical

insulation requirements.

f. Portable Ladders. All portable ladders shall have nonconductive side rails if they are used where the employee

or ladder could contract exposed live parts operating at 50 volts or more or where an electrical hazard exists.

Nonconductive ladders shall meet the requirements of current ANSI standards for ladders.

g. Periodic Testing. Insulating materials, hot sticks and tools (etc.) shall be periodically tested and/or inspected

according to manufacturer’s requirements. The PHP Electrical Supervisor is responsible to determine testing

facility and establish a Tracking System (See APPENDIX “H” Page 20) to ensure this requirement is met. A

competent qualified person may be designated to track equipment inspections.



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19. Rubber Insulated Equipment Voltage Requirements



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APPENDIX A

Physical Plant Job Briefing and Job Planning Check Sheet

Employee in Charge: ______________ Date: _______

Job Location: ______________Project: ____________



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APPENDIX B

Risk Assessment Procedure



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APPENDIX C

Physical Plant Energized Electrical Work Permit

This permit is required for any work in which a person or object will approach closer than the

Restricted

Approach Boundary to energized (live) parts operating at 50 volts or more.

EXEMPT ACTIVITIES: PPE and electrically rated equipment is still required, however the

following do not

Require this permit to be completed.

• Testing and troubleshooting, including voltage and current testing.

• Breaker and switch operation with covers closed or safe.

• Activities to lockout/tagout equipment.

• Installation of barriers to make the job safe.

• Tightening a 110 AC terminal screw.

• Removing a cover to perform an IR scan.

Before initiating this work…..

Can this job be avoided? Yes ☐ No ☐

Is there a safer way to do this work? Yes ☐ No ☐

Can it be shut down? Locked/Tagged? Yes ☐ No ☐

Can it be delayed until such a time that it can be shut down? Yes ☐ No ☐

Can Voltage Rated Barriers be installed to eliminate the hazard? Yes ☐ No ☐

If one or more of these questions is “Yes”, then use this method and use a normal Job

Briefing for this work. If all are “No” proceed with an Energized Electrical Permit.

Why does it have to be done energized? (Check all that apply)

☐ It is part of a Continuous Process that can’t be shut down.

☐ Emergency System

☐ Hazardous Location Ventilating System?

☐ Creates additional hazards or infeasible due to equipment design or limitation?

If none of these items are checked, Energized Electrical work is not allowed and the

equipment should be

shut down and locked out!

Instructions to electrically Qualified Individual (Permit Issuer):

Verify/Fill out permit daily

All items on the permit must be checked or filed out

Insure proper PPE

Sign permit

Review project plan and secure acknowledgement signatures

Notify designated 1st Aid/CPR site Safety Coordinator

Post permit at job site

Note: Once work is completed, return this form to your supervisor

Emergency information: Dial 911 for emergency response



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Physical Plant Energized Electrical Work Permit

Energized Electrical work being done by:

5. Means to keep unqualified people out: ____

Employee: __________________________ ______________________________________

Date: ______________________________

Permit expires: (time) _________________ 6. Additional Safety Work Practices Employed:

Job/WO number: _____________________ ______________________________________

Job location: _________________________ ______________________________________

Flash Hazard Boundary______________ ______________________________________

Flash Hazard Category (Circle) and ______________________________________

Protection Required: __________________________or none ☐

0 1 2 3 4 7. Other job hazards: _____________________

See page 16 for Personal Protection Equipment _______________________________________

required. _______________________________________

Description of circuit equipment: __________ __________________________or none ☐

_____________________________________ 8. Job briefing/planning checklist filled out

_____________________________________ Yes ☐ No ☐

_____________________________________ 9. ERT/FRT and technical community been

_____________________________________ notified Yes ☐ No ☐

_____________________________________ 10. >150V: identify observer if working alone on

Description of work being done: __________ work or N/A ☐ : ________________________

_____________________________________ 11. Do you agree that this work can be

_____________________________________ performed safely?

_____________________________________ Signature (s)

Note: See Arc Flash Label for some of the ____________________________Yes ☐ No ☐

Following information: Use Power Feed Label ____________________________Yes ☐ No ☐

In absence of local label: ____________________________Yes ☐ No ☐

MAXIMUM VOLTAGE EXPOSED: (CIRCLE) If “No”, stop work and report to your Supervisor.

150-300V, 300V to 750V, >750V specify: ____

___________________________AC ☐ DC ☐

Voltage being worked on: (circle) 12. Do you acknowledge that you have reviewed

<150V, 150-300V, 300V to 750V, >750V this job at the worksite with the electrically

If >750V specify: ____________AC ☐ DC ☐ qualified worker?

1. Prohibited Approach Boundary: (Permit

Requirements) Physical Plant Electrical Supervisor

<300V – Avoid contact Name: __________________________________

300 to 750V – One inch Signature: _______________________________

>750V – Seven inches (up to 15,000 volts)

2. Shock Protection Boundary (Restrictive Department/Maint./or Engineering Manager

Approach Boundary) _______________ Name: __________________________________

3. Shock Hazard PPE Required (Circle Signature: _______________________________

Required Elements)

-Voltage Rated Gloves/Leathers Once the work is complete, forward this form

Class Required (Circle): 00, 0, 1, 2, 3, 4 to Safety Department for review and

-Voltage Rated Tools Yes ☐ No ☐ retention.

4. Limited Approach Boundary: (Unqualified

People Entry Distance) _______________



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APPENDIX D

Field Label

480 VAC 0

0

42 inch

12 inch

PPE REQUIREDShock Hazard

Glove Class Long Sleeve Shirt with Pants - Non-

melting to untreated natural fiber,

Safety Glasses, Electric Hazard

Safety Leather Foot Wear, Voltage

Rated Gloves with Leather

Protector, Hearing Protection

Limited Approach

Restricted Approach

WARNING Qualified Persons Only

Arc Flash and Shock Hazard

18 inch Flash Protection

Boundary

≤ 1.2 cal/cm

2

Flash Hazard

at 18 inches



17

APPENDIX E

Approach Boundaries AC Current



18

APPENDIX F

Approach Boundaries DC Voltage



19

APPENDIX G

Safety Acknowledgement Sheet

This is to acknowledge that I have received a copy of Physical Plant’s Energy Control Procedure,

Lockout/Tagout Program and a copy of UNI’s Physical Plant Electrical Safety Work Practices Program.

These programs establish minimum safe work practices and procedures for workers exposed to electrical

hazards in the workplace.

This also acknowledges that I have been informed that the work practices and procedures of my employees

exposed to electrical hazards in the course of their work under the contract with UNI will be equal to or

more stringent that the work practices and procedures outlined in the programs above.

Date: _____________________ Job Number (if applicable): ____________________

Project/Job Title: _________________________________________________________

Contract Employer: _______________________________________________________

Signature: ______________________________ ___________________________________

Contract Employer Signature Contract Employer, Print

Signature: ______________________________ __________________________________

UNI Witness Signature UNI Witness, Print



20

APPENDIX H

Tracking PPE Inspections

UNI Physical Plant will inspect PPE and track this information at a minimum.

Calibration Due Report As of: ____________________

Tool No Location Description Tool

Type

Date

Out

Serial No Condition Test

Cal

Date



21

APPENDIX I

Arch Flash Hazard Identification Table

Continued



22

Continued



23



24

APPENDIX J

Arch Flash Hazard Identification AC Voltage



25

APPENDIX K

Arch Flash Hazard Identification DC Voltage



26

APPENDIX L

Table 130.7 I (16) 2012 edition Protective Clothing and Personal Protective Equipment (PPE)

Electrical Safety Program Work Practices for Qualified ......Electrical Safety - Work Practices...

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