ATTACHMENT M

YANSAB

ELECTRICALLY HAZARDOUS TASK PLAN / PERMIT

(WRITTEN JOB PLAN)

To be completed, attached to Request for shutdown and submitted to Site Management for authorization.

1. Specify voltage levels involved:

2. Classification Factors (Check all appropriate categories):

hot work _____________ voltage testing _____________ proximity work ____________

other hazardous work ______________________________________________________________
high-level voltage _______________ low-level voltage _______________
high-level energy _______________ low-level energy _______________

3. Placement of Barriers:__________________________________________________________________

____________________________________________________________________________________

4. Personal Protection:
a. voltage-rated gloves
b. leather gloves _____________________________________________________________________
c. voltage-rated equipment (test equipment):
voltage sensing ____________________________________________________________________
voltage measuring__________________________________________________________________
other ____________________________________________________________________________
d. guarded / insulated tools _____________________________________________________________
e. Nomex body protections_____________________________________________________________
f. Nomex hood ______________________________________________________________________
g. hard hat _______________ h. face shield ___________ i. safety glasses ___________
j. chemical protection ________________________________________________________________
k. other ____________________________________________________________________________

5. Barricades and Signs: __________________________________________________________

6. Equipment:
How old? _______________________ Last Maintained? ___________________________
Visual inspection before beginning? _______________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

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 ATTACHMENT M

7. Physical force on equipment? Special concerns? ___________________________________

Agreement of ID information, drawings and actual arrangement?

8. References used to prepare the plan (manuals, drawings, sketches):

____________________________________________________________________________________

____________________________________________________________________________________

9. Special concerns / precautions: ___________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

10. Emergency information: ________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

11. Review and Authorization:**

____________________________________ ___________________________________
Plant Electrical Representative Date Engineer (Coordinator) Date

____________________________________ ___________________________________
Electrical Superintendent Date Lead Engineering Date

____________________________________
Safety Specialist Date

____________________________________ __________________________________
Resident Manager Date (Space provided for additional signature) Date
(Resident Engineer)

12. Job plan review with craftspersons performing work ___________________________________

Crafts persons’ signatures: __________________________________________________
__________________________________________________
__________________________________________________

** Where a signature is not required, mark N/A.

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WORK OUTLINE
Step-By-Step Outline Of Work

(CAUTION: WORK MUST STOP AND BE RE-EVALUTED IF IT CANNOT BE EXECUTED AS

PLANNED, OR IF CONDITIONS CHANGE. STOP WORK – CONTACT FOREMAN)

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