Electrical Safety SWMS Form

Job / task name

Work order or reference number

Site / project name

Exact work location

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Start date

Date

Expected completion date

Date

Brief description of electrical work and task type

Prepared by

First NameMiddle NameLast Name

Company / contractor name

Supervisor / responsible person

First NameMiddle NameLast Name

Team members / workers involved

Subcontractors involved

Electrical Hazards, Risks and Controls

Lockout/Tagout or isolation method used

Test-for-dead procedure

Barricading and signage controls

Required supervision level

Permit control required

Overall risk rating after controls

Additional control measures or comments

Required PPE

Tools, Equipment and Test Instruments

Inspection Checks for Leads and Tools

Permit-to-Work or Isolation Permit Details

Emergency Shutdown Procedure

First Aid / CPR or Site Emergency Contact

Incident Response Steps and Additional Site-Specific Safety Notes

Confirmation that controls have been explained and understood

Supervisor/approver name

First NameMiddle NameLast Name

Supervisor/approver signature

Date of approval/sign-off

Date