📍 When to use this template
- Before starting any new electrical installation, testing, commissioning, or maintenance work.
- A new permit is required for each specific task or for each shift, as decided by the Safety Officer.
- Filled by the Contractor's Site Engineer/Supervisor, checked by the PMC/Client's Electrical Engineer, and approved by the Safety Officer.
Sections & fields
Preview of the template structure. Download Excel to fill on site.
1Header / Project Info8 fields
Project Name
_____________
Contract / Package No.
_____________
Date & Time of Request
_____________
Permit Validity (From Date/Time)
_____________
Permit Validity (To Date/Time)
_____________
Prepared By (Contractor)
_____________
Approved By (PMC/Client Safety)
_____________
2Work Details & Location6 fields
Exact Location of Work (Building/Floor/Grid Ref)
_____________
Description of Electrical Work
_____________
Equipment / Circuit ID to be worked on
_____________
Voltage Level (e.g., 230V, 415V, 11kV)
_____________
Is it a new installation or maintenance?
_____________
Drawing Reference No.
_____________
3Hazard Identification & Risk Assessment (HIRA)6 fields
HIRA / JSA Reference No.
_____________
Potential Hazards Identified (Electric Shock, Arc Flash, Fire, Falls from height)
_____________
Control Measures Implemented
_____________
Emergency Contact Person & Number
_____________
Location of Nearest First Aid Station
_____________
Location of Nearest Assembly Point
_____________
4Pre-Work Safety Checklist (LOTO & Isolation)8 fields
Isolator/Breaker Identified & Switched Off?
_____________
Lock-Out Tag-Out (LOTO) Applied? (Yes/No/NA)
_____________
LOTO Lock Number(s) & Key Holder Name
_____________
Voltage Confirmed Zero using Calibrated Multimeter?
_____________
'Men at Work' / 'Danger' Signage Displayed?
_____________
Area Barricaded with Warning Tape?
_____________
Proper Earthing Provided (if required)?
_____________
Fire Extinguisher (CO2/DCP) available at work spot?
_____________
5Personal Protective Equipment (PPE) Checklist6 fields
Electrical Safety Helmet (IS 2925)
_____________
Safety Shoes (IS 15298)
_____________
Insulated Hand Gloves (IS 4770) - Checked for leaks?
_____________
Face Shield / Arc Flash Suit (as per HIRA)
_____________
Cotton Overalls (No synthetic clothing)
_____________
Insulated Tools Checked?
_____________
6Work Completion & Permit Closure8 fields
Work Completed (Yes/No)
_____________
All Tools & Materials Removed?
_____________
Area Cleaned & Housekeeping Done?
_____________
LOTO Locks & Tags Removed by authorized person?
_____________
Circuit Re-energized?
_____________
Closed By (Contractor Supervisor)
_____________
Time of Closure
_____________
Verified By (PMC/Client Engineer)
_____________
💡 Sample filled excerpt
Description of Electrical Work: DB dressing and termination for Lighting Panel LP-02-04 in Tower A, 2nd Floor. LOTO Applied?: Yes. LOTO Lock Number(s): CON-E-112, CON-E-113. Voltage Confirmed Zero?: Yes, checked by Mr. Ramesh Kumar with calibrated multimeter (ID: MM-08).
⚖ Compliance notes
- Helps comply with the Building and Other Construction Workers (BOCW) Act, 1996, and Central Rules, 1998 (Rule 47: Electrical Hazards).
- Ensures adherence to the Central Electricity Authority (Measures relating to Safety and Electric Supply) Regulations, 2010.
- Provides documented proof of Lock-Out Tag-Out (LOTO) procedure, a key requirement during safety audits.
- Fulfills general duty of care clauses found in most construction contracts (e.g., FIDIC Clause 4.8 - Safety Procedures).