Summary Statement
A form for a power line awareness permit that allows you to enter information about the site and the steps that you will be taking to maintain safety.
| Construction Safety Council recommends filing out one of these before any project begins- to help prevent electrocutions. |
Power Line Awareness Permit
Today's Date _____________
Job Number ____________
| Contractor Name | |||
| Job Address | |||
| Telephone Number | Fax Number | ||
| Emergency Contact Number |
| Survey |
Before beginning
any project, you must first survey your work area to find power lines
at the job site. (See job site sketch on reverse side)
| Identify |
After finding all
of the power lines at your site, identify the activities you'll be doing
that may put you or your workers at risk. Mark one or more of the following:
Cranes (mobile or truck mounted) |
Aerial lifts |
|
Drilling rigs |
Dump trucks |
|
Backhoes/Excavators |
Ladders |
|
Long-handed tools |
Material Handling & Storage |
|
Other tools/high-reaching equipment |
Scaffolding |
|
Concrete pumper |
Other____________ |
| Eliminate or Control |
After identifying
the power line and high-risk activities on our job site, we must determine
how to eliminate or control the risk of electrocution (a successful determination
is often reached only after consultation with the utility). Mark one or
more of the following:
|
Move the activity |
Use barrier protection (insulated sleeves) |
|
Change the activity |
Use an observer |
|
Have the utility de-energize the power line |
Use warning lines with flags |
|
Have the utility move the power line |
Use non-conductive tools |
|
Use a protective technology |
|
|
Insulated link Boom cage guard Proximity device
|
Always maintain your
minimum safe clearance distance from the power line, except when the utility
has de-energized and visibly grounded the power line.
|
|
|
| Less than 50 kV | 10 feet |
| More than 50 kV | 10'+(0.4")(# of kV over 50 kV) |
|
WARNING!
It is unlawful to operate any piece of equipment within 10' of energized lines |
Jobsite
sketch
(draw in location of power lines and their proximity to construction site, include such things as; proposed excavations, location of heavy equipment, scaffolding, material storage areas, etc.)
Completed by_____________________ Date__________
Title_____________________
Approved by______________________ Date__________
Title_____________________
