Job Safety Analysis Form

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Optional

Steps to Complete Job

Can Equipment be de-energized?

Limited

Restricted

Required if working on energized voltage
Arc Flash Hazard Determination Method

Fill out either Calculated Incident Energy Method or PPE Category, but not both

Check Arc Flash Sticker on equipment or Power study

ONLY if Incident Energy has not been completed

Reference NFPA70E – Tables 130.5(C) 130.7(C)(14) 130.7(C)(15)(a) 130.7(C)(15)(b) 130.7(C)(15)(c)

General PPE (all Jobs)
This PPE is generally expected to be required on all jobs.
* First Aid Kits and Fire Extinguishers provided and accessible at the work location by the Client or other Contractor can meet this requirement.
PPE for work on Energized Equipment

SELECT THE REQUIRED PPE BASED ON THE VOLTAGE AND THEN THE INCIDENT ENERGY (SELECT ONLY 1 GROUPING)

PPE < 1000V Energized

PPE > 1000V Energized

Incident Energy <12cal
Incident Energy >12cal
Incident Energy >12cal

NOTE: Safety Glasses and Ear Protection required with Face Shield or Arc Flash Hood

Other PPE may include Safety Harness, Blocking equipment, Lanyards, lights, etc
Is Glove Certification Current?
All electrical insulating gloves that are used on a job may be inspected before each job AND have a valid certification date stamped on the glove. Used gloves need to be re-certified every 6 months. Unused gloves need to be certified ever 1 year.
Job Leader Check List
The Job Leader should verify that each of the following areas are reviewed prior to commencing work on the job. Items that are not able to be confirmed or completed should be addressed below.
(ex: Client does not have One-Lines; NoHazCOM chemicals present, etc

see above for explanation

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