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Time / Date: 5/26/2023 9:32:29
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JSP ID: 1104
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Scope of Work: Indoor motor replacement
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Work Order: W0307492
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Building: 46
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Person in Charge: Antonio collado
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Lead / Supervisor: Delgado, Alex
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Logged Email: juanjuarez37@lbl.gov
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Division: Facilities
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QEW Level: QEW 2
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Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
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Second Person Requirement: Safety Watch
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Second Person Identified: Antonio collado
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List Other Participants:
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Affected Persons Notified: Yes
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Switching: Hazardous Switching
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Panel / Equipment ID: 49A2A6A/46AC022
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System Information Review: Arc Flash Labels
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Control of Hazardous Energy: Simple LOTO
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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
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Sequence of Job Steps
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List basic sequence of steps from start to finish.
After safety briefing and LOTO AND ZVV procedures we rill removed old indoor motor from 46AC022 and install new motor ,test unit and return to prior cooling and heat settings |
Control of Work Area
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Minimum Approach Boundary: 42
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Barricade Tape / Attendant: Attendant
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Shock Risk Assessment
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System Voltage: 277/480 V ac
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Limited Approach Boundary: 42 inches
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Restricted Approach Boundary: 12 inches
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Will the hands enter the RAB: Yes
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Voltage Glove Class: 0
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Will any other part of the body enter the RAB: No
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Arc Flash Risk Assessment
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Incident Energy: 0.77 cal/cm2
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Arc Flash Boundary: 14
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Working Distance: 18 inches
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Arc Flash PPE Level: 4
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Incident Energy Reduction Measures: 0
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Capacitor Hazards
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Capacitor Bus Voltage:
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Capacitor total stored energy (joules):
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Discharge wait time (minutes):
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Emergency Response Plan
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Nearest Landline Location: Inside building 46 second floor
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Emergency Number to Call: 7911
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Sufficient cell phone signal? Yes
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Clear exit path? Yes
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AED Location: Portable
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Fire Extinguisher Location: Inside second floor
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Contact release method available and tested: Rescue hook, Voltage gloves
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Environmental Conditions
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Does the environment present additional hazards that should be addressed?
Fall hazard |
Error Precursors
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Task Demands:
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Work Environment:
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Individual Capabilities:
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Human Nature:
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Error Precursor Mitigations:
Fall hazard / wear fall PPE |
PPE Inspections
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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, Fall ppe |
Notes / Other
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Perform Job Breifing
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PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.
A Job Briefing at a minimum must include:
Rev 2023.08.22.1 Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov |