Da Form 5168 R PDF Details

The DA 5168 R form, officially titled "Safety Clearance Order (Electrical Facilities)," is a critical document within the domain of electrical safety and facility management, especially within the United States Army Corps of Engineers (USACE) operations. Its use, governed by the technical manual TM 5-682, highlights the structured approach to ensuring the safety of electrical installations and maintenance activities. The form encompasses a variety of components, each designed to meticulously record details such as the order number, identification of the station or installation, and specific line or equipment involved. Furthermore, it provides a clear framework for documenting the timing of safety clearance procedures, including when these clearances are applied and subsequently removed, ensuring a rigorous process to mitigate hazards associated with electrical facilities. The form also necessitates the identification of personnel involved in the issuance and release of clearances, including signatures and exact times, fostering accountability and traceability within electrical operation activities. Understanding the DA 5168 R form is pivotal for professionals involved in the safety and operational management of electrical facilities, codifying standard procedures to uphold high safety standards in line with USACE guidelines.

QuestionAnswer
Form NameDa Form 5168 R
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesNOV, proponent, USACE, YYYYMMDD

Form Preview Example

SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES)

For use of this form, see TM 5-682; the proponent agency is USACE

1.

ORDER NUMBER

2. OTHER NUMBERS

3. STATION/INSTALLATION

 

 

 

 

4.

LINE OR EQUIPMENT INVOLVED

 

5.TIME APPLIED (Read Down)

6. DETAILS OF CLEARANCE PROCEDURES

7.TIME REMOVED

(Read Up)

8a. ISSUED TO

8c. TIME ISSUED

9a. RELEASED BY

9c. TIME RELEASED

8b. ISSUED BY

8d. DATE ISSUED (YYYYMMDD)

9b. ACCEPTED BY

9d. DATE RELEASED (YYYYMMDD)

DA FORM 5168-R, JUNE 1999

DA FORM 5168, NOV 82, IS OBSOLETE

APD LC v1.00

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NOV completion process outlined (step 1)

2. After the last section is complete, you're ready include the essential specifics in allowing you to progress further.

Completing segment 2 in NOV

3. This subsequent segment should be pretty straightforward, a ISSUED TO, c TIME ISSUED, a RELEASED BY, c TIME RELEASED, b ISSUED BY, d DATE ISSUED YYYYMMDD, b ACCEPTED BY, d DATE RELEASED YYYYMMDD, DA FORM R JUNE, DA FORM NOV IS OBSOLETE, and APD LC v - every one of these blanks needs to be filled in here.

The way to fill in NOV portion 3

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