Power Line Awareness Permit

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Construction Safety Council

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  


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)


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:

Checkbox Cranes (mobile or truck mounted) Checkbox Aerial lifts
Checkbox Drilling rigs Checkbox Dump trucks
Checkbox Backhoes/Excavators Checkbox Ladders
Checkbox Long-handed tools Checkbox Material Handling & Storage
Checkbox Other tools/high-reaching equipment Checkbox Scaffolding
Checkbox Concrete pumper Checkbox 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:

Checkbox Move the activity Checkbox Use barrier protection (insulated sleeves)
Checkbox Change the activity Checkbox Use an observer
Checkbox Have the utility de-energize the power line Checkbox Use warning lines with flags
Checkbox Have the utility move the power line Checkbox Use non-conductive tools
  Checkbox Use a protective technology
    Checkbox Insulated link
    Checkbox Boom cage guard
    Checkbox 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.

Distance from Power Line
Less than 50 kV 10 feet
More than 50 kV 10'+(0.4")(# of kV over 50 kV)

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__________


Approved by______________________ Date__________