Time / Date: 5/23/2023 7:37:01
JSP ID: 1078
Scope of Work: Investigate Inop 85 AHU 06 & Controller
Work Order: W0327353
Building:
Person in Charge: J. Colmenares
Lead / Supervisor: Cameron, Benjamin
Logged Email: josephpica@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification, Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Standby Person
Second Person Identified: Joseph Pica
List Other Participants: NONE
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: MCC-M357A1A7A1A-(CB)A6 85AHU06
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Not energizing equipment for the first time, or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish.

Request Permission PPE, Switch, LOTO, ZVV Investigate, possible Mode2 Work

Control of Work Area

Minimum Approach Boundary: 78
Barricade Tape / Attendant: Attendant

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: No
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 13cal cal/cm2
Arc Flash Boundary: 78”
Working Distance: 18 inches
Arc Flash PPE Level: 4
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: No Cap
Capacitor total stored energy (joules): No Cap
Discharge wait time (minutes): No Cap

Emergency Response Plan

Nearest Landline Location: Adjacent Corridor
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Crew Carry - On Site
Fire Extinguisher Location: Adjacent Corridor
Contact release method available and tested: Upstream breaker or switch, 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:

Constant Communication Verbatim Repeat Back Re- brief as Necessary

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

NOTE: Haz Energy Controls Options: No Multiple Selections Allowed - We Are Starting Under Simple LOTO & IAW Job Scope will likely go Mode2 to troubleshoot

Perform Job Breifing

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 2023.08.22.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov