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WPR869C - Work Permit - 2
WPR869C - Work Permit - 2
WPR869C - Work Permit - 2
Project Name
Permit Duration
Bus ID 220-MC-941
Job/Work Order Number 12345
Title
Name
Signature
Date
Limbert Gomez
08/02/2015
1. Detailed job description procedure to be used in performing the above detailed work: Limpieza de MCC
2. Description of the safe work practices to be employed: Uso de EPP aducado segun valor de energia incidente
3. Results of the Shock Hazard Analysis
4. Determination of Shock Protection Boundaries:
5. Results of the Flash Hazard Analysis:
6. Determination of the Flash Protection Boundary
7. Necessary personal protective equipment to safely perform the assigned task:
8. Means employed to restrict the access of unqualified persons from the work area:
9. Evidence of completion of a Job Briefing including discussion of any job-related hazards:
Bus ID 220-MC-941
Equipment Name
0,4 kV
0m
00
Glove V-Rating
500 VAC
Incident Energy
1,65 cal/cm
0,3 m
1,4 m
1,1 m
Work Distance
116,1 cm
Energy Level
Level A
PPE - Non-melting or untreated natural fiber long-sleeve shirt and long pants
Do you agree the above described work can be done safely? Yes
Title
Name
Date
Serapio Copa
08/01/2015
Esequio Espinoza
08/01/2015
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Bus ID 220-MC-941
Job/Work Order Number 12345
Name
Signature
Limbert Gomez
Date
08/01/2015
Note: Once the work is complete, forward this form to the site Safety Department for review and retention.
EL PERSONAL COMPETENTE LLENARA ESTE PERMISO DE TRABAJO.
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Identif y
The Hazards
The voltage levels involved
Skills required
Any foreign (secondary source) voltage source
Bus ID 220-MC-941
Job/Work Order Number 12345
Ask
Can the equipment be de -energized
Are backfeeds of the circuits to be worked on possible?
Check
Job plans
Single -line diagrams and vendor prints
Status board
Information on plant and vendor r esources is up to date
Safety procedures
Vendor information
Individuals are familiar with the facility
Know
What the job is
Who else needs to know Communicate!
Who is in charge
Think
About the unexpected eventWhat if?
Lock Tag Test Try
Test for voltage FIRST
Use the right tools and equipment, including PPE
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