Version: 2

ZINGELECTRIC ELECTRICAL WORK PERMIT Validity:

01/20/2018

In case of any doubt, consult the Procedures

1. INDUSTRIAL SAFETY MANUAL ELECTRICAL SECTOR.

TO

DAY (dd) MONTH (mm) YEAR (yy) START TIME FINAL HOUR

DATE OF DILIGENCE: ESTIMATED DURATION TIME:

N° EXECUTING PEOPLE:
LOCATION OF WORK TO BE DONE: TEAM OBJECT OF THE WORK:
DESCRIPTION OF THE WORK TO BE DONE:

< 50 Volts DC 110 Volts AC 2,400 Volts AC 13,200 Volts. A.C.

THE WORK IS LOW VOLTAGE: 120 Volts DC 220 Volts AC THE WORK IS MEDIUM VOLTAGE: 4,160 Volts AC 44,000 Volts. A.C.
6,300 / 6,600 Volts AC
< 50 Volts AC 480 Volts AC
TOOLS AND/OR EQUIPMENT TO USE:

ADDITIONAL PERMISSIONS
ATS SAFE WORK ANALYSIS WORK PERMIT IN CONFINED SPACES
HOT WORK PERMIT ENERGIZED WORK PERMIT

SAFE WORK PERMIT AT HEIGHTS 5 MINUTE PRE-OPERATIONAL MEETING AND/OR EQUIPMENT CONSIGNMENT

VERIFICATION OF 5 GOLDEN RULES ELECTRICAL SAFETY

GROUNDING AND SHORT-CIRCUIT ALL POSSIBLE VOLTAGE SOURCES SIGNALING AND
VISIBLE CUTOUT OF ALL VOLTAGE SOURCES
DELIMITATION OF THE WORK AREA
LOCKOUT AND TARGET OF EQUIPMENT
VERIFICATION OF ABSENCE OF VOLTAGE

d ASSOCIATED RISKS

ADJACENT LIVE LINES (ENERGIZED): TOXIC GASES FROM ELECTRICAL EQUIPMENT: OTHERS:

AND ADDITIONAL PRECAUTIONS BUT

IS A WORK SURVEILLANCE REQUIRED? IS FIRE FIGHTING EQUIPMENT REQUIRED ON HAND?

IS PERMANENT SST ACCOMPANIMENT REQUIRED? WAS ADEQUATE PLANNING OF THE WORK TO BE EXECUTED MADE?

REQUIRED PERSONAL PROTECTION EQUIPMENT AND ELEMENTS

ADDITIONAL TO THE BASIC PPE (HELMET, GOGGLES, GLOVES, PROT. HEARING, LONG SLEEVE SHIRT AND INDUSTRIAL TYPE PANTS)
DIELECTRIC HELMET FALL PROTECTION EQUIPMENT DIELECTRIC GLOVES VOLTAGE LEVEL:
ACID VAPOR RESPIRATOR DIELECTRIC BOOTS DIELECTRIC MAT TENSION LEVEL: POLE
DUST OR FUME RESPIRATOR LENGTH AND TENSION LEVEL:
FIREPROOF SUIT
GLASSES OR SPECIAL MASK
PROXIMITY TENSION SENSOR OTHERS
HEALTH STATUS / MEMBERSHIP AND TRAINING :

IS THE PERSON WHO WILL CARRY OUT THE WORK IN HEALTH AND SUITABLE PHYSICAL CONDITION?
IS THE PERSON WHO WILL PERFORM THE WORK TRAINED AND EXPERIENCED IN ELECTRICAL WORK?
HAS THE PERSON IN CHARGE OF EXECUTING THE WORK RECEIVED INSTRUCTIONS AND PRECAUTIONS TO FOLLOW IN PERFORMING THE TASK?
□ HAS THE PERSON PERFORMING THE WORK BEEN MADE KNOWN ABOUT THE SPECIFIC RISKS AND CONTROL METHODS BEFORE STARTING THE ACTIVITY?
NAME AND SIGNATURE OF AUTHORIZED PERSONNEL

AS EXECUTOR: I HAVE VERIFIED THE CONTROLS IN THE FIELD WITH THE ISSUER TO MINIMIZE THE RISKS ASSOCIATED WITH THIS WORK, I HAVE VERIFIED THAT THE CONDITION OF THE TOOLS, EQUIPMENT AND
PERSONAL PROTECTION ELEMENTS IS OPTIMUM FOR THEIR USE.
NAME POST ID AND REGISTRATION SIGNA
TURE

PERMIT ISSUANCE SIGNATURES SIGNATURES CLOSING THE PERMIT

AS ISSUER RESPONSIBLE FOR THE PERMIT: I HAVE VERIFIED IN THE FIELD WITH THE THE WORK HAS BEEN FINISHED
EXECUTOR THE CONTROLS TO MINIMIZE THE RISKS ASSOCIATED WITH THIS WORK AND THE SITE AND EQUIPMENT ARE LEFT IN SAFE CONDITION WITH THE AREA CLEAN AND FREE
I CONSIDER IT TO BE SAFE TO PROCEED WITH THE EXECUTION OF THE SAME. OF WASTE AND MATERIALS
EXECUTOR RESPONSIBLE FOR THE PERMIT : I PERSONALLY DECLARE THAT:
 NAME, SIGNATURE AND REGISTRATION OR CC RESPONSIBLE
ISSUER
AS RESPONSIBLE EXECUTOR FOR THE PERMIT: I HAVE VERIFIED IN THE FIELD WITH THE ISSUER
THE CONTROLS TO MINIMIZE THE RISKS ASSOCIATED WITH THIS WORK AND I CONSIDER
SAFE TO PROCEED WITH THE EXECUTION OF THE SAME.
NAME, SIGNATURE AND REGISTRATION OR CC RESPONSIBLE
EXECUTOR
OBSERVATIONS:
NAME, SIGNATURE AND REGISTRATION OR CC
EXECUTOR
ISSUER RESPONSIBLE FOR THE PERMIT: I HAVE PERSONALLY VERIFIED THAT:
THE AREA IS CLEAN AND FREE OF WASTE AND MATERIALS
THE PERMIT HAS BEEN DEFINITELY SUSPENDED
IF THE WORK HAS BEEN COMPLETED, THE SAFETY PROTECTIONS (CUTS,
ALARMS, LOCKS, ETC).
NAME, SIGNATURE AND REGISTRATION OR
CC TRANSMITTER
 INSPECTION LIST FOR GRANTING ELECTRICAL WORK PERMITS
2 ELECTRICAL
Version 1
Validity:
01/20/2018

SITUATION TO OBSERVE YEAH NO NA OBSERVATIONS

Power sources are de-energized/disconnected and locks installed

Are the individual locks and tags correctly located at the locking points?

Do electrical equipment, devices and tools have adequate insulation, and is the voltage
being inspected?

Do the performers know the procedures for entering an area with an energized line?

Appropriate PPE was provided for working on live lines with tension. volts and
_____Amp?

Are the extension cords in good condition, are they inspected regularly and are they not
amended?

Is the emergency lighting in the area working correctly?

Have all power tools been inspected before use for their casing and electrical
connection?

Does the substation have a unified diagram, risk map and command scheme?

The executors are carrying the ground connection kit, voltage detector (13.8 Kv) without
mechanical contact, batons

Are there dielectric mats throughout the entire operating area, substation command
panels and primary cabin?

Do the materials, tools and equipment comply with the applicable technical standards?

Is the appropriate clothing being worn for work near energized circuits?

Were all accessories for personal use of the work performers removed?