Electrical Hot Work Permit
To Be Reviewed by Team Leader Prior to Start Of Work
Valid for Technician and Day Issued Only
| Date: | Time: | Maximum Voltage Present: |
| Machine Number and Description: | ||
| Specific Reason Equipment Must Be Energized For Servicing: | ||
Personal Protective Equipment Worn:
< > Flash Resistant Jacket
< > Insulating Gloves
< > Face Shield
< > Rubber Mats
< > Hard Hats
< > Other (List each additional item individually)
Time Work Completed: |
Date |
| Technician's Name: | |