Risk AssessmentGreenfield, IA Equipment & Panel ID Name * Reported Malfunction * Voltage * 480 240 120 Is your meter rated for this voltage? No Yes Hazard risk level * Employees are not permitted to troubleshoot, open or perform work on Hazard Risk Level 2 and above. 0 (0-1.2 cals) 1 (1.21 to 12 cals) 2 (12.1 and above) Limited approach boundaries: Restricted approach boundary: Arc flash boundary: Arc flash calorie rating: Has a physical barrier been placed to mark the furthest boundary? No Yes What PPE is required? (information on label) Cotton undergarments Natrual-fiber T-shirt Arc-rated long-sleeved shirt/pants Hard hat with arc-rated shield Leather gloves Arc-rated balaclava Hearing protection Electrical-rated shoes (heavy-duty leather) Safety glasses Rubber gloves (inspect expiration date & air test before each use) Inspection date: MM DD YYYY Other risks in the area: Water present Lift truck traffic Other Other risks: Company Name(s) Date MM DD YYYY Thank you for completing the risk assessment.Your form has been submitted.
