ATTACHMENT 2

Form 000.653.F0277
Energized Electrical Work Permit
Page 1 of 6

Instructions: The Supervisor responsible for work required on equipment/systems that cannot be de-energized and
when equipment/system voltage is 50 volts or higher coordinates preparation and approval of an Energized Electrical
Work Permit.
SECTION 1
Instructions: The Supervisor responsible for work completes this section.
Project Number: Location/Building:

Permit Requestor Name: Equipment ID:

Permit Date: Permit Expiration:

Describe the work to be conducted on equipment/systems operating at voltages of 50 volts or higher:

Yes No
Is de-energization infeasible due to design or operational limitations of the equipment/system?
Will de-energization result in increased or additional hazards?
Will de-energization result in the deactivation of emergency equipment (e.g., life support, alarm
systems, critical ventilation, etc.)?
If there is an option to de-energize without introducing additional or increased hazards, do not perform energized electrical work.

Explain the specific reason for performing energized work that support the selections made:

SECTION 2
Instructions: The Equipment/System Owner Completes this section.
Company Name: Authorizer Name:

Authorizer Phone: Authorizer Title:

Authorizer Signature: Date:

Copyright © 2023, Fluor Corporation. All Rights Reserved. Health, Safety, and Environmental
Revision Date: 5Oct2023
 Form 000.653.F0277
Energized Electrical Work Permit
Page 2 of 6

SECTION 3
Instructions: The Contractor providing energized electrical services completes this section.
Contractor Company Name: Contract Number:

Contractor Representative Requesting and Authorizing Energized Electrical Work:

Has a completed Form 000.653.F0100, Job Safety Analysis, or an equivalent that includes a detailed description of the
job procedures to be used in performing the work, safe work practices, and the results of the shock risk assessment
including the voltage to which personnel will be exposed, limited approach boundary, restricted approach boundary,
and necessary shock, personal, and other protective equipment to safely perform the assigned task have been
submitted to Company for review.

Is a subcontractor performing the work? No

Yes, then, what is the subcontractor company name?
Has Contractor HSE reviewed and verified the list of subcontractor personnel who are authorized by the
subcontractor’s management to perform the energized electrical work? Yes No
Power Source
What is the most hazardous power source at the energized electrical work location?

Voltage: Location:

Arc Flash Category 1: 1 2 3 4 Arc Flash Boundary:

Which method of arc flash risk assessment was used?

Incident Energy Analysis Method (Arc Flash Assessment) 2 (Method 1, Page 3)
Arc Flash PPE Category Method 3 (Method 2, Page 4)
Assign PPE4 and clothing selections using either Page 3 or Page 4 based on the method selected above.

1
Arc Flash Categories: 1 (Arc-Rated Clothing, Minimum Arc Rating of 4 cal/cm2 (16.75 J/cm2)); 2 (Arc-Rated Clothing, Minimum Arc
Rating of 8 cal/cm2 (33.5 J/cm2)); 3 (Arc-Rated Clothing Selected so that the System Arc Rating meets the required Minimum Arc
Rating of 25 cal/cm2 (104.7 J/cm2)); and 4 (Arc-Rated Clothing Selected so that the System Arc Rating meets the required Minimum
Arc Rating of 40 cal/cm2 (167.5 J/cm2))
2
Refer to NFPA 70E – Standard for Electrical Safety in the Workplace – Effective Date: 06/21/2020. 130.5 Arc Flash Risk Assessment.
3
Refer to NFPA 70E – Standard for Electrical Safety in the Workplace – Effective Date: 06/21/2020, Table 130.7(C)(15)(a) Arc Flash
PPE Categories for Alternating Current (ac) Systems and Table 130.7(C)(15)(b) Arc Flash PPE Categories for dc systems.
4
Equipment is required to meet appropriate ANSI, ASTM, NFPA 70E standards and Equipment/System Owner PPE requirements.
Copyright © 2023, Fluor Corporation. All Rights Reserved. Health, Safety, and Environmental
Revision Date: 5Oct2023
 Form 000.653.F0277
Energized Electrical Work Permit
Page 3 of 6

SECTION 3 – Method 1: Incident Energy Analysis (Arc Flash Assessment) PPE and Clothing Requirements 5
Legend Incident Energy Exposures
R: Required
SR: Selection Required =1. cm2 up to 12 
>12 cal/cm2
AN: As Needed (optional) cal/cm22 ca./
Note: The checklist () is used during completion of Section 4.
Arc-rated clothing with an arc rating equal to or greater than the estimated
R R
incident energy 6
Arc-rated Long-sleeve Shirt and Pants Arc-rated Coverall Arc Flash Suit SR SR
Arc-rated Face Shield and Arc-rated Balaclava Arc Flash Suit Hood 7 SR
Arc-rated Arc Flash Suit Hood 7 R
Arc-rated Outerwear (e.g., jacket, parka, rainwear, hard hat liner) AN AN
Heavy-duty leather gloves Arc-rated gloves
Rubber insulating gloves with leather protectors 8, select glove class: SR
00 0 1 2 3 4
Arc-rated gloves
Rubber insulating gloves with leather protectors 8, select glove class: SR
00 0 1 2 3 4
Hard hat R R
Safety Glasses Safety Goggles SR SR
Hearing protection R R
Leather footwear 9 R R

5
Equivalent to NFPA 70E – Standard for Electrical Safety in the Workplace – Effective Date: 06/21/2020, Table 130.5(G) Selection of
Arc-Rated Clothing and Other PPE.
6
Arc ratings can be for a single layer, such as an arc-rated shirt and pants or a coverall, or for an arc flash suit or a multi-layer system
if tested as a combination consisting of an arc-rated shirt and pants, coverall, and arc flash suit.
7
Face shields with a wrap-around guarding to protect the face, chin, forehead, ears, and neck area are required. Where the back of
the head is inside the arc flash boundary, a balaclava or an arc flash hood shall be required for full head and neck protection.
8
Rubber insulating gloves with leather protectors provide arc flash protection in addition to shock protection. Higher class rubber
insulating gloves with leather protectors, due to their increased material thickness, provide increased arc flash protection (i.e., Class
00 (500 max V), Class 0 (1,000 max V), Class 1 (7,500 max V), 2 (17,000 max V), Class 3 (26,500 max V), and Class 4 (36,000 max V)).
9
Footwear other than leather or dielectric shall be permitted to be used provided it has been tested to demonstrate no ignition,
melting, or dripping at the estimated incident energy exposure.
Copyright © 2023, Fluor Corporation. All Rights Reserved. Health, Safety, and Environmental
Revision Date: 5Oct2023
 Form 000.653.F0277
Energized Electrical Work Permit
Page 4 of 6

SECTION 3 – Method 2: Arc Flash PPE and Boundary Determination PPE and Clothing Requirements10
Legend Arc Flash PPE Category 1
R: Required
SR: Selection Required

AR: As Required 1 2 3 4
AN: As Needed (optional)
The checklist () is used during completion of Section 4.
Arc-rated long-sleeve shirt and pants or arc-rated coverall R R
Arc-rated long-sleeve shirt AR AR
Arc-rated pants AR AR
Arc-rated coverall or arc-rated arc flash suit jacket and arc-rated arc flash suit pants
Arc-rated coverall AR AR
Arc-rated arc flash suit jacket AR AR
Arc-rated arc flash suit pants AR AR
Arc-rated face shield 11 or arc flash suit hood R
Arc-rated flash suit hood or arc-rated face shield 11 and arc-rated balaclava R
Arc-rated arc flash suit hood R R
Arc-rated Gloves Rubber Insulating Gloves with Leather Protectors 8 SR SR
Arc-rated jacket, parka, rainwear, or hard hat liner AN AN AN AN
Hard hat R R R R
Safety Glasses Safety Goggles SR SR SR SR
Hearing protection (ear canal inserts) 12 R R R R
Heavy-duty Leather Gloves Arc-rated Gloves
Rubber Insulating Gloves with Leather Protectors 8, select glove class: SR SR
00 0 1 2 3 4
Leather footwear 13 AN R R R

10
Equivalent to NFPA 70E – Standard for Electrical Safety in the Workplace – Effective Date: 06/21/2020, Table 130.7(C)(15)(c)
Personal Protective Equipment (PPE).
11
Face shields are to have wrap-around guarding to protect not only the face but also the forehead, ears, and neck, or, alternatively,
an arc-rated arc flash suit hood is required to be worn.
12
Other types of hearing protection are permitted to be used in lieu of or in addition to ear canal inserts provided they are worn
under an arc-rated arc flash suit hood.
13
Footwear other than leather or dielectric shall be permitted to be used provided it has been tested to demonstrate no ignition,
melting, or dripping at the minimum arc rating for the respective arc flash PPE category.
Copyright © 2023, Fluor Corporation. All Rights Reserved. Health, Safety, and Environmental
Revision Date: 5Oct2023
 Form 000.653.F0277
Energized Electrical Work Permit
Page 5 of 6

SECTION 4
The Supervisor uses this section to lead and document a pre-task meeting with the Contractor.
The names of the Authorized Workers performing this job are:

The Standby Persons name is:

The Job Safety Analysis, including the documented arc flash risk assessment, Safety Task Assignment, and written
procedures for complex or especially hazardous tasks are finalized and attached to this permit.
Current first aid and CPR14/AED15 certifications for the Authorized Workers and Standby Person have been verified.
The Authorized Workers and Standby Person have completed the site’s required hazardous energy control and electrical
safety training.
An arc flash boundary/protection area, that includes proper signage, has been established to restrict access of unauthorized
persons from the work area.
Area employees have been notified of the location of impending hazardous work and the access restrictions.
Crew members that will be performing the work are wearing the required PPE specified in Section 3 (use the gray checklist
() checklist column in Section 3 as an aid to verify each item).
Crew members are not wearing synthetic fabrics or blends next to their skin.
Crew members have removed jewelry.
Crew members do not have conductive articles or exposed fasteners on clothing.
PPE test dates have been verified.
Tools and test equipment are maintained and have been inspected.
Tools and test equipment at the worksite are compatible with the voltage present.
Test equipment was tested on a known source.
Electrical insulating blankets are used to cover exposed transformer terminals prior to starting the work on power
distribution units if the end panels are removed.
Insulating rubber blankets/mats have been suitably placed.
Nonconductive ladders meet the requirements of ANSI A14.5.
Suitable lighting is in place to perform the work.
Crew members understand that working alone on energized circuits is prohibited.
Minimum 26-inch aisle leading to the work area has been established.
Area in front of panel is clear.
Emergency communication means and location are documented on the STA.
Crew members understand the emergency procedures.
The Standby Person can request emergency assistance.
The Standby Person knows where and how to disconnect/shut off the main power.
A shepherd’s hook or a similar insulated tool is available to free a person from an energized circuit in the event of contact.
Emergency provisions include availability of an automatic external defibrillator (AED).

14
CPR: Cardiopulmonary Resuscitation
15
AED: Automated External Defibrillator
Copyright © 2023, Fluor Corporation. All Rights Reserved. Health, Safety, and Environmental
Revision Date: 5Oct2023
 Form 000.653.F0277
Energized Electrical Work Permit
Page 6 of 6

SECTION 5
Instructions: The Authorized Workers and Standby Person that will perform the energized electrical work associated with this permit acknowledge that they
are properly trained, experienced, equipped, and have the appropriate knowledge, tools, and protective equipment to safely perform the work via signature
below.
Name Role Date Signature

SECTION 6
Instructions: The Supervisor responsible for the work verifies that sections 1 -5 of the permit are completed and obtains each of the required signatures
below before the work may commence. Signature indicates review of the work plan and that the Authorized Workers and Standby Person have been briefed
on task and hazards, properly trained and experienced, have the appropriate tools and protective equipment, and are approved to perform the work
described in the permit.
Role Name Date Signature
Contractor Energy Marshal

Fluor Authorized Permit Issuer

Site HSE Project Lead

Project Manager

Program Director or

Construction Director

Copyright © 2023, Fluor Corporation. All Rights Reserved. Health, Safety, and Environmental
Revision Date: 5Oct2023