Subcontractor Electrical Worker Qualification Form
Contract or Purchase Requisition # Company Name_____________________________________________________________________________
Non-PNWD staff Name
Name_______________________________________________________________________ A qualified electrical worker is anyone whose immediate manager has determined to have the skills and knowledge related to the construction and operation of the electrical equipment and installations and has received safety training on the hazards involved. Only those persons that are both qualified and authorized may install, fabricate, repair, test , calibrate or modify electrical or electronics wiring, devices, systems or equipment. Part 1 JobSpecific Criteria Criteria Select the type of work the electrical worker will perform. De-Energizing Diagnostic and Testing Energized
Describe the job-specific function or activities to be performed: (i.e., specific equipment authorized to service) __________________________________________________________________________ 2 Electrical Work Experience Determine experience necessary to perform the activity described in Part 1 above. Degree Journeyman Electrician Vendor-supplied training Vendor name________ Date______ Classroom training (list course number) Course number _______ Date ______ Years Relevant Experience ______
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Formal Training
Identify formal training required to perform the activity described in Part 1. Electrical Worker Safety Training PPE including arc-flash equipment First Aid/CPR Lock & Tag
Describe on the job training that has been or needs to be completed. On-the-job training may be required for specified equipment or classes of equipment associated with facility power (for work on feeders, distribution panels, branch circuits, etc.) and Laboratory systems (for work on R&D equipment). ______________________________________________________________________ I hereby certify the non-PNWD staff listed above is qualified to perform the activities specified in Part 1. Non-PNWD staff member’s Supervisor/Manager ___________________________ Qualified Person _____________________
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On-the-job training
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