**Fermilab**

**ELECTRICAL HAZARD ANALYSIS / WORK PERMIT (EHAWP)**

**For Selected Work Activities on the AC Power Distribution System or
Electrical Utilization Equipment**

**JOB NAME & LOCATION:**

**EFFECTIVE DATES OF PERMIT: Start: End:**

**WORK TO BE PERFORMED BY:**

**QUALIFIED PERSON IN CHARGE: PHONE:**

**Does the Work Involve Diagnostic Energized Work? Yes No** (Includes
LOTO Verification)

**Does the Work Involve Manipulative Energized Work? Yes No**
(Justification Required)

**Is an Inspection Required After Work is Completed? Yes No** (Reqd for
New AC Pwr Installs)

**If the Work Activity Involves Manipulative Energized Work, State the
Justification Here.**

**DESCRIPTION OF WORK:**

**ASSOCIATED HAZARDS:**

**HAZARD MITIGATION: Indicate Hazard/Risk Category ( -1, 0, 1, 2, 2\*, 3
or 4 ):**

[SHOCK PROTECTION BOUNDARIES for ENERGIZED WORK]{.underline}

from NFPA 70E Table 130.2(C) for Fixed Circuit Parts and Article
130.3(A). Indicate if Otherwise.

For 120/208 VAC: Shock Protection: Limited Approach: 3\' 6\". Restricted
& Prohibited Approach: Avoid Contact

For 480/277 VAC**: Shock Protection: Limited Approach:** 3\' 6\"**.
Restricted Approach:.** 1 Ft**. Prohibited Approach:** 1\"

Class Voltage-Rated Gloves and Leather Protectors Required for Subject
Work Activity

**[ARC-FLASH PROTECTION BOUNDARY and REQUIRED PPE for ENERGIZED
WORK]{.underline}**

PPE Requirements for Shock & Arc Flash Protection are Fully Described in
NFPA 70E, Article 130.7. Indicate if Otherwise.

Clothing Must be Non-Melting or Untreated Natural Fiber, Unless
Specified as Flame-Resistant (FR).

The Fermilab Default Flash Protection Boundary is 4 Feet (as Qualified
by Article 130.3(A) at 300 kA Cycles)

**If Calculated, Indicate Flash Protection Boundary:** **feet and/or
inches**

**If Calculated, Indicate Incident Energy Level for Arc Flash
Protection:** **cal/cm^2^**

**HRC -1** Short-Sleeve Cotton T-Shirt, Long Cotton Pants, Safety
Glasses (0 to 1.2 cal/cm^2^)

**HRC 0** Long-Sleeve Cotton Shirt, Long Cotton Pants, Safety Glasses (0
to 1.2 cal/cm^2^)

**HRC 1** FR Coverall, Safety Glasses, Hard Hat, Leather Protectors or
Gloves (\>1.2 to 4 cal/cm^2^)

**HRC 2** Cotton Clothing under FR Coverall, Safety Glasses, Hard Hat,
Arc-Rated Face Shield, Hearing Protection, Leather Protectors or Gloves,
Leather Work Shoes (\>4 to 8 cal/cm^2^)

**HRC 2\*** Cotton Clothing under FR Coverall, Safety Glasses, Hard Hat,
Double-Layer Switching Hood, Hearing Protection, Leather Protectors or
Gloves, Leather Work Shoes (\>4 to 8 cal/cm^2^)

**HRC 3** Cotton Clothing under 2 FR Coveralls, Safety Glasses, Hard
Hat, Flash Suit Hood, Hearing Protection, Leather Protectors or Gloves,
Leather Work Shoes (\>8 to 25 cal/cm^2^)

**HRC 4** Cotton Clothing under Multilayer FR Flash Suit Jacket and
Pants Safety Glasses, Hard Hat, Flash Suit Hood, Hearing Protection,
Leather Protectors or Gloves, Leather Work Shoes (\>25 to 40 cal/cm^2^)

**PREPARED BY: Date:**

**APPROVED BY: Date:**

[ADDITIONAL APPROVALS FOR MANIPULATIVE ENERGIZED WORK]{.underline}

> **Approval of D/S Electrical Coordinator**
>
> **Approval of Area Division/Section Head**
>
> (FESS Head Must Sign if FESS Electricians are Performing Manipulative
> Energized Work Under this Permit for Another D/S)
>
> **Approval of Fermilab Directorate**

**[Job Briefing Signature Sheet]{.underline}**

**Person(s) Conducting Briefing:** **Date:**

Personnel Present at the Job Briefing will Sign Below, thereby
Indicating their Understanding of the Scope of Work and Associated
Hazard Mitigation Requirements.

**[Print Name]{.underline} [Fermi ID \#]{.underline} [Div/Sec or
Company]{.underline} [Signature]{.underline}**