Templates
Permit to work electrical form

Permit to work electrical form

Formalize electrical work authorization with comprehensive safety verification, isolation procedures, and qualification checks to prevent electrical accidents.

Use this template
or download pdf
Permit to work electrical form

Formalize electrical work authorization with comprehensive safety verification, isolation procedures, and qualification checks to prevent electrical accidents.

Use this template
or download pdf

Managing electrical work safety requires specialized documentation. Our permit to work electrical form addresses this need with dedicated sections for voltage specifications, isolation points, and electrical-specific hazard controls. When facing complex electrical maintenance tasks—like switchgear repairs or panel upgrades—this template creates a clear safety protocol and authorization chain

As stated by OSHA, electrical hazards contribute to approximately 1.2 million injuries worldwide annually. The form’s verification process ensures you implement safety measures before energizing or de-energizing equipment.

Related categories

Preview of the template
Page 1
Job Details
Job Number
Job Description
Date
Start Time
Expected Completion Time
Work Type
Type of Electrical Work
Isolation & Permit Scope
Equipment/Circuit to be Isolated
Reason for Isolation
Isolation Method
Voltage Level
Potential Hazards Identified
Permit Scope
Permit Issuer Approval
Name of Issuer
Issuer Signature
Date
Worker Acceptance
Name of Worker
Worker Signature
Date
Permit Closure
Work Satisfactorily Completed
Reason if No
Name of Approver
Approver Signature
Date

Frequently asked questions

When is an electrical permit to work form required?

An electrical permit to work form is required when conducting work on electrical systems that pose significant safety risks, including work on live circuits, high-voltage equipment, complex electrical installations, equipment requiring lockout/tagout procedures, and electrical maintenance in hazardous environments.

Who needs to sign off on an electrical permit to work form?

An electrical permit to work form typically requires signatures from the qualified electrical worker performing the task, a supervisor or manager responsible for the area, and a safety officer or representative. Sometimes you’ll also need a sign-off from a specialized electrical engineer for high-risk work.

How can you ensure your electrical permit to work process is effective?

Ensure effectiveness by training all relevant staff on the permit system, conducting thorough risk assessments before issuing permits, and verifying worker qualifications. It’s important to implement clear communication protocols as well and regularly audit the permit process for compliance and improvement.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.