Power Line Awareness Permit

Today's Date _____________ Job 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:

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____________

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.

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_____________________