Electrical Work Risk Assessment Checklist

Electrical Work Risk Assessment Checklist
Company:*
Date*
MonthDayYear
Date
Time
:HourMinutesAM/PM Option
Name*
First NameLast Name
Phone Number
Area CodePhone Number
Your Email*
example@example.com
Your Supervisors Email
example@example.com
Site Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Equipment Reference
e.g. DB 2
Can the work be undertaken while the electrical equipment is de-energised?*
YesNo

	Yes
Cramped working conditions
Confined spaces
Multiple sources of supply
Damp situation
Environmental factors, e.g. heat, cold, vibration and noise
Height (working at heights and danger of falling objects)
Operational pressures to carry out the work or to restore electricity supply
Unstable work area
Conductors, cable or equipment under tension or likely to fall
Proximity of other work functions and other mobile plant and equipment
Working below ground
Corrosive and toxic materials
Radiation, e.g. microwave antennas, radio towers, mobile phone antennas, radar
Material containing asbestos
Hazardous substances, e.g. PCBs
Other energy sources, e.g. stored, mechanical, pneumatic, hydraulic and gravitational
Accumulation of dust
Inappropriate practices and procedures

Clothing / PPE Requirements
CAUTION!
SAFETY OBSERVER REQUIRED
Your risk assessment has determined that a safety observer is necessary for any work on or near exposed energised conductors or live conductive parts
- low voltage rescue kit
- Electrical first aid kit
- Long Sleeve Shirt & Pants (natural fibres)
- Safety Glasses or Goggles
- Arc Rated FR Shirt & FR Pants or FR Coverall minimum arc rating of PPE 4 cal/cm²
- Arc Rated face shield with chin cup
- Fire resistant gloves
- Rubber Mat
- ISSC 14 Electrical First Aid kit
- Arc Rated FR Shirt & FR Pants or FR Coverall minimum arc rating of PPE 8 cal/cm²
- Arc Rated face shield with chin cup
- Fire resistant gloves
- Rubber Mat
- ISSC 14 Electrical First Aid kit
- Safety Observer
- LV Rescue Kit
- Layers of Arc Rated FR Shirt & FR Pants or FR Coverall and Arc Flash Suit minimum arc rating of PPE 25 cal/cm²
- Arc Rating Hood ATPV min 25 Cal/cm2
- Insulated gloves with leather or fire resistant outers gloves
- Safety Observer
- Low Voltage Rescue Kit
- ISSC 14 Electrical First Aid kit
- Rubber Mat
- Layers of Arc Rated FR Shirt & FR Pants or FR Coverall and Arc Flash Suit minimum arc rating of PPE 40 cal/cm²
- Arc Rating Hood ATPV min 40 Cal/cm2
- Insulated gloves with leather or fire resistant outers gloves
- Safety Observer
- Low Voltage Rescue Kit
- ISSC 14 Electrical First Aid kit
- Rubber Mat
State any additional safety equipment, tools or controls required for the work:
Should be Empty:

	Yes	No
Do you have approved test instruments suitable for the task?
Have you checked that the test instruments are functioning correctly?
Have you isolated the supply eg by switching off?
Have you conclusively tested that the equipment is de-energised?
You must carry out the electrical work in accordance with any safe work method statement that must be prepared for the work.

	Yes	No
Is the work area clear of obstructions to allow for easy access?
Is the isolation point clearly marked or labelled and capable of being operated quickly?
Has the person with management or control of the workplace been consulted about the proposed electrical work?
Do you have a safe work method statement for the task at hand? This should state the control measures required to eliminate or minimise the risks
Are you trained, competent and confident in applying the particular procedures or techniques that are required for the task?
Have you checked to ensure that your tools and accessories are insulated and have been inspected and maintained to ensure they are serviceable?
Is your test equipment appropriate to the task and functioning correctly?

Clothing / PPE Requirements