Follow the steps to complete the Electrical Work Hazard Assessment form.

1. Click ‘Get Form’ button to access the assessment form and open it for completion.
2. Enter the job/work order number, job location, and equipment details in the designated fields. This information helps identify the scope of work.
3. Answer question 1 regarding exposure to energized electrical conductors or circuit parts. Select 'Yes' or 'No' as applicable based on the nature of the job.
4. In the shock hazard analysis section, specify the voltage level and approach boundaries. Carefully choose the correct voltage from the list provided and enter the corresponding approach boundaries.
5. Indicate if an arc flash analysis has been performed. If 'Yes', provide details on the PPE category, arc flash boundary, and incident energy. If 'No', detail the appropriate PPE based on NFPA guidelines.
6. Determine if the equipment can be de-energized, locked, and tagged out for safety prior to the task. Select 'Yes' or 'No', and if 'No', be aware that an Energized Electrical Work Permit is required.
7. Identify potential non-electrical hazards associated with the work environment. Check all applicable hazards listed, such as falls, chemical exposure, and extreme temperatures.
8. Select all personal protective equipment (PPE) and safety measures that will be utilized during the task. Ensure all boxes are checked for the required safety gear.
9. Complete the form by signing with your name, date, and signature. Ensure all information is accurate before submission.
10. After completing the assessment, save your changes, download a copy for your records, and print or share the form as necessary.

Complete your Purdue University Electrical Work Hazard Assessment online today to promote a safe working environment.