☑ Mode 0 - Electrically Safe Work Condition ☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Mike Rose
Other Participants
None
Affected Persons Notified
N/A
System / Equipment
Switching
Hazardous Switching
Panel / Equipment ID
Disc 16A & panel 208A
System Information Review
☑ Panel Schedules ☑ Arc Flash Labels
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑ Properly installed ☑ 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
Shut off power to disconnect 16A, ZVV, LOTO, enter panel 208A, ZVV, Replace CB 4, replace dead front, re-energize
Control of Work Area
Minimum Approach Boundary
42 in
Barricade Tape / Attendant
Warning - Orange
Shock Risk Assessment
System Voltage
277/480 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
12 inches
Will the hands enter the RAB
Yes
Voltage Glove Class
0
Will any other part of the body enter the RAB
No
Arc Flash Risk Assessment
Incident Energy
1.1 cal cal/cm2
Arc Flash Boundary
18in
Working Distance
18 inches
Arc Flash PPE Level
4
Incident Energy Reduction Measures
0
Capacitor Hazards
Capacitor Bus Voltage
Capacitor Total Stored Energy (Joules)
Discharge Wait Time (Minutes)
Emergency Response Plan
Nearest Landline Location
Emergency Number to Call
7911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
South wall
Fire Extinguisher Location
West wall
Contact Release Method Available and Tested
Rescue hook, Voltage gloves
Environmental Conditions
Does the environment present additional hazards that should be addressed?
None
Error Precursors
Task Demands
Time pressure (in a hurry), Simultaneous or multiple tasks
Work Environment
Distractions/interruptions
Individual Capabilities
Human Nature
Error Precursor Mitigations
N/A
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 ☑ Insulated tools ☑ Multimeter and other electrical test instruments
