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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 5/12/2023 7:57:46
JSP ID: 1024
Scope of Work: repair or replace the juicebox ev charger.

General Information

Work Order
325692
Building
-
Person in Charge
Jared Tissot
Lead / Supervisor
Secheck, Stephen
Logged Email
jtissot@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
NA
Other Participants
NA
Affected Persons Notified
N/A

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
253b1a27a
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
Simple LOTO
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
preform switching. implement loto. preform zvv. repair or replace ev charger. energize and test ev charger after work has been completed.

Control of Work Area

Minimum Approach Boundary
42 in
Barricade Tape / Attendant
Danger - Red

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
12 inches
Will the hands enter the RAB
No
Voltage Glove Class
00
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
12.3 cal/cm2
Arc Flash Boundary
77 in
Working Distance
18 inches
Arc Flash PPE Level
2
Incident Energy Reduction Measures
00

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location
b46 hallway
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
b46
Fire Extinguisher Location
b46
Contact Release Method Available and Tested
Voltage gloves

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
none

PPE Inspections

☑ Safety glasses (ANSI Z87)
☑ Arc-rated clothing (flash suit
☑ daily wear) including face shield
☑ balaclava
☑ hood.
☑ 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