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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 5/11/2023 9:46:14
JSP ID: 1018
Scope of Work: Verify circuit and panel number of receptacle underneath FPU-72 and LANStar

General Information

Work Order
W0325592
Building
-
Person in Charge
Greg Neidiger
Lead / Supervisor
Secheck, Stephen
Logged Email
gcn@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
Greg Neidiger
Other Participants
Armand Uribe (performing switching)
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
39A1A-4
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
Equipment Condition
☑ Properly installed
☑ Properly maintained
☑ All doors and covers closed and fully latched
☑ No signs of impending failure
☑ Not energizing equipment for the first time
☑ or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish
1) Check for presence of voltage at outlet 2) If outlet has voltage, perform switching of suspected circuit 39A1A-4 3)Verify absence of voltage at receptacle

Control of Work Area

Minimum Approach Boundary
Barricade Tape / Attendant

Shock Risk Assessment

System Voltage
No Shock Hazard Present
Limited Approach Boundary
42 inches
Restricted Approach Boundary
3 inches
Will the hands enter the RAB
No
Voltage Glove Class
Not Required
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
8.69 cal/cm2
Arc Flash Boundary
62
Working Distance
18 inches
Arc Flash PPE Level
2+
Incident Energy Reduction Measures
Not Required

Capacitor Hazards

Capacitor Bus Voltage
Capacitor Total Stored Energy (Joules)
Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
East corridor
Fire Extinguisher Location
End of corridor
Contact Release Method Available and Tested
No shock hazard present

Environmental Conditions

Does the environment present additional hazards that should be addressed?
None

Error Precursors

Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
Had discussion of potential precursors. None were identified for this task

PPE Inspections

☑ Safety glasses (ANSI Z87)
☑ Arc-rated clothing (flash suit
☑ daily wear) including face shield
☑ balaclava
☑ hood.
☑ Hearing protection
☑ Rubber insulating gloves and leather protectors
☑ Non-melting footwear that fully covers the feet
☑ Removal of conductive articles
☑ Multimeter and other electrical test instruments

Notes / Other

Perform Job Briefing

PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.

A Job Briefing at a minimum must include:
  1. Detailed Scope of Work
  2. Shock and arc flash hazards for each task
  3. Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
  4. Work area controls (barricades, signs, attendants)
  5. Emergency Response Plan
Rev 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov