A free permit for justified energized work. It starts with a de-energize-first gate, then the justification, shock and arc-flash assessments, approval and closeout. Take the fillable PDF to print and post, the Word version to adapt the wording to your site, or the Excel workbook to complete it with dropdowns.
Get it free in PDF, Word or Excel for determining whether a permit is required and documenting justified energized work.
Two working pages plus a separate guidance page. One permit per task per shift. If the scope changes, stop, re-plan and brief the team again.
Two working pages plus a separate guidance page. One permit per task per shift. If the scope changes, stop, re-plan and brief the team again.
An energized electrical work permit documents justified work on or near energized conductors or circuit parts when the task meets the employer’s permit trigger. It records why an electrically safe work condition will not be established, and how shock and arc-flash risks will be controlled.
De-energizing is the default. The permit is not a shortcut around the employer’s electrical lockout/tagout procedure.
Answer the four Part C questions in sequence before any assessment begins.
Write the task-specific reason energized work is justified, not cost or schedule pressure.
A qualified person completes or verifies both assessments using current site information.
Work through the eleven practices, the job safety plan, the briefing and emergency arrangements.
The designated authority signs, then the permit is posted at the work location.
Secure the area, document any problems, close the permit and retain it per your program.
OSHA does not prescribe this permit form. The template helps document the employer’s justification and electrical safe-work process, but using it alone does not establish compliance.
OSHA 1910.333. Establishes the de-energize-first duty and the conditions for justified energized work.
OSHA 1910.335. Addresses safeguards such as PPE, signs, barricades and attendants.
NFPA 70E 2027. Provides the energized electrical work permit mechanism and its permit elements.
This template is provided as general guidance. Site-specific procedures and the requirements of the authority having jurisdiction, insurer and other applicable authorities take precedence. Have a competent person review and adapt the template before use. Confirm citations against the standard editions your site holds. This is safety information, not legal advice.
The baseline permit-to-work form for non-routine work that needs authorization and closeout.
View template ProcedureThe de-energize-first route the Part C gate sends you to when an ESWC can be established.
View template PermitFor permit-required confined-space entry, with monitoring log and entrant roster.
View templateNeed a live view of permits, approvals, isolations and closeout status? Zentri digitizes the full permit lifecycle.