Resolute Forest Products
Coosa Pines

Electrical Safety Pre-Approval
Training Evaluation Checklist

Contractors, Outside Service, and other non-Resolute Forest Products Coosa Operations Personnel

This checklist is intended to verify prior Electrical Safety training for each individual employed by outside contractors, outside services vendors, and any other Non-Resolute Forest Products Coosa Pines Operations personnel who will be performing work at the Coosa Pines Operatons site that exposes, or could expose them to electrical hazards. Because of the variety of hazards, job tasks, experience, and expertise of individuals exposed to electrical hazards, training required for a specific individual to be considered Qualified for specific tasks will vary.

It is possible, and in fact likely that individuals trained and considered Qualified for some tasks are Unqualified for others. Training given to your employees shall be specific to the job tasks and the electrical hazards present. Multiple individuals from the same organization having the same training can be indicated by attaching a listing of the names, and by supplying all required documentation for each individual as listed in "B) Qualifications and Documentaton" below.

"Resolute Forest Products is not hereby assuming the liability for ensuring the contractor's compliance with the NFPA 70-E standards, nor for the contractor's employee's actions, negligence, or omissions. The contractor is required to ensure compliance with the NFPA 70-E standards by its employees, as well as each of its employee's compliance with applicable Resolute Forest Products, local, State, and/or federal laws, regulations, policies and procedures."

NOTE: Send completed form to Resolute Forest Products Coosa Pines Operations Safety & Health for approval prior to beginning to work.

Contractor Representative
Please list the names of all personnel to whom the answers on this document apply (ie names of personnel who received this specific training):
Evaluated By:

NOTE: If "No" is checked on any question, an explanation is required in the comments section below.

A) Has the individual received training on:
     1) FPA 70E-2009, Standard for Electrical Safety in the Workplace?
     2) Emergency procedures related to electrical injury:
          a. Emergency First Aid, Emergency Response and Reporting?
          b. CPR?
          c. Proper methods of releasing victims from contact with energized conductors?
     3) Advanced training for Electrically Qualified Persons including:
          a. The potential safety hazards from work on or near electrical conductors, equipment, and circuit parts, and ways to avoid or eliminate the hazards?
          b. The proper Personal Protective Equipment and Safe Work Practices to be used?
          c. System and personal protective grounding?
          d. Job Hazards Analysis?
          e. The electrical hazards involved with working on or near:
                   a. 120/208/277/480 volt power, lighting, transformers, motors, breakers, starters, etc?
                   b. 5 KV/15KV transformers, breakers, motors, starters, disconnects, etc?
                   c. High voltage substation / large power distribution equipment?
                   d. Overhead lines, open bus systems?
     4) Has the individual successfully put into practice their understanding of the requirements through some method of "hands-on" or "on-the-job" Electrical Safety Related Work Practices skills demonstration?
          a. Did this skills demonstration include the ability to:
                   i. Distinquish live parts from other parts?
                   ii. Determine the nominal voltage?
                   iii. Determine the Arc Flash Hazard?
                   iv. Determine the proper Personal Protective Equipment needed?
                   v. Determine the proper Safe Work Practices to be used?
                   vi. Determine the proper Safe Approach Distances?
                   vii. Properly use electrical test equipment?
     5) Has the individual received Electrical Safety periodic refresher training?
B) Qualifications and Documentation
Note: At the discretion of the Resolute Forest Products Coosa Pines Operations representative, evidence of proper documenation can be supplied in lieu of actual documentation.
          a. Has proper documentation of the content of the training been supplied?
          b. Was some method of testing used to demonstrate understanding of the training?
          c. Has proper documentation of this testing been supplied?
          d. Has proper documentation of emergency procedures training, including CPR been supplied?
          e. Has proper documentation of the successful courses completion been supplied?
          f. Has proper documentation of the qualifications of the instructor been supplied?
          g. Are the orientation content, testing, instructor qualifications, and documentation satisfactory?