QEW 1 / 2 / 3 Job Safety Plan

General Information

Work Order

W0324228

Building

B026

Person in Charge

J.Colmenares

Lead / Supervisor

Cameron, Benjamin

Logged Email

josephpica@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 0 - Electrically Safe Work Condition

QEW Level

QEW 2

Second Person Requirement

Standby Person

Second Person Identified

Pica

Other Participants

for PMTs

Affected Persons Notified

Yes

System / Equipment

Switching

Hazardous Switching

Panel / Equipment ID

E43A5A-10 AHU-2-26

System Information Review

☑ Panel Schedules
☑ Arc Flash Labels

Control of Hazardous Energy

Simple LOTO

Equipment Condition

☑ 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

Permission Brief Switch LOTO CONFIRM Return to Service

Control of Work Area

Minimum Approach Boundary

52”

Barricade Tape / Attendant

Attendant

Shock Risk Assessment

System Voltage

120/208 V ac

Limited Approach Boundary

42 inches

Restricted Approach Boundary

Avoid Contact

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

8.12cal cal/cm2

Arc Flash Boundary

52”

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 Office

Emergency Number to Call

x(7)911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

Corridor

Fire Extinguisher Location

Corridor

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

Brief Maintain Communication

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

Notes / Other

none

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan