ELECTRICAL WORK PERMIT № EWP 00001 attachment to GWP no______
I. Details
Task description:________________________________________
Location of work:________________________________________
Attachment to GWP no.____________
Date:____________
Requested by:__________________________________________
Contractor/Performer Name
Risk Assessment attached to the permit ? Yes / No
The Drawing attached to the permit ? Yes / No
Prepared by:
____________________________________________________
Name of Contractor or Performer / Signature/Date
Method statement and risk assessment was checked and verified
by:
_____________________________________________________
ACC Technical Supervisor/ Name /Signature,/Date)
Reviewed and recommended by:
____________________________________________________
ACC Safety Coordinator/ Name /Signature/Date)
Permitted to Proceed by:
____________________________________________________
ACC Line Manager Name ( HOD)/ Signature/ Date)
III. Work completion & turn over:
1. The work for which this Permit was issued has been installation.
properly performed;
2. All tools, equipment, and electrical apparatus affected by electrical panels and enclosures, control
the work have been left in a safe, clean condition.
Turned over by: ___________________________
Performer
M.M.Other,
Checked & verified by:
I commit to Implement and monitor the above safety controls
conditions on site until the job is completed. I understand that
____________________________________________
failure to implement will be grounds for cancellation of this permit
ACC Technical Supervisor
by: ___________________________________________
ACC Safety Coordinator
Accepted_____________________________________
by:
_______________________________________
Performer’s Name/ /Signature/ Date
ACC Line Manager (HOD)
II. Safety Controls
DANGER!!!
 Fatality or Injury through electric shock
 Stored electrical charge
DO NOT DO ANY ELECTRICAL WORKS UNTIL THE
FOLLOWING PRECAUTIONS HAVE BEEN TAKEN!
Performer have to check each item:
1. The location where the work is to be done have
been personally examined by the Technical Supervisor.
2. Plans and details have been provided to
determine details and embedded item.
3. The following safeguards have been provided:
Yes No
A. All Electrical hazards present in the
workplace (working on or near high voltage
installations, equipment, etc) are assessed
and appropriate control measure has been
taken
B. All works are to be done by qualified
personnel
C Ensure correct and inspected Electrical tools
to be used
D. Ensure correct PPE is specified and worn
E. Warning signs shall be installed on access
points to each electrical installation
F. The electrical equipment is fitted with a
valid inspection tag.
G. All fittings/ connections on electrical power
leads are free from damage (no exposed wires
or connections)
H.Emergency shut off devices are installed at
each installations.
İ. if required equipment are isolated in
accordance with the ACC Project’s isolations
and lock out requirements.
J. After completion of the installation, all
personnel who will operate the electrical
equipment shall receive instruction for the
safe operation of this equipment or
K .Access to electrical installations (including
centers, transformers, substations) are
restricted to authorized personnel
L. No electrical enclosure, containing live
connections, to be left open and unattended.
please
All power specify
outlets should be heavy industrial
typesuitable for outdoor use.