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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 5/23/2023 12:17:46
JSP ID: 1087
Scope of Work: Test

General Information

Work Order
TEST
Building
78
Person in Charge
Mike R
Lead / Supervisor
Other
Logged Email
mvr@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 1
Second Person Requirement
Not Required
Second Person Identified
Other Participants
Affected Persons Notified
N/A

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
TEST
System Information Review
☑ Single Line Drawing
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
Testing

Control of Work Area

Minimum Approach Boundary
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
120/208 V ac
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
0 cal/cm2
Arc Flash Boundary
0
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
Minimum PPE for Electrical Work
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
Sufficient Cell Phone Signal
Clear Exit Path
Yes
AED Location
Fire Extinguisher Location
Contact Release Method Available and Tested

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

☑ TEST

Notes / Other

TEST

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