Time / Date: 6/2/2023 12:41:50
JSP ID: 1129
Scope of Work: LOTO out equipment E208 to put in electrically safe work condition. Isolation will be at disc 16A
Work Order: Training
Building: 75A
Person in Charge: Jeff jendrick
Lead / Supervisor: Lee, Michael
Logged Email: jlhendrick@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Mike Rose
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: ET208
System Information Review: 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.

Notify affected user, set up barricade and signage, open disconnect Disc16A and apply personal LOTO lock. ZVV load side of disconnect Disc 16A

Control of Work Area

Minimum Approach Boundary: 46”
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: Yes
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 5.6 cal/cm squared at 18” cal/cm2
Arc Flash Boundary: 46”
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: N/A
Capacitor total stored energy (joules): N/A
Discharge wait time (minutes): N/A

Emergency Response Plan

Nearest Landline Location: No land line
Emergency Number to Call: 510-468-7911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: On wall inside training room in 75A
Fire Extinguisher Location: Back door entrance to room
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting

Error Precursors

Task Demands: Time pressure (in a hurry), Repetitive actions or monotony, Critical steps or irreversible acts
Work Environment:
Individual Capabilities:
Human Nature: Stress (limits attention), Complacency/overconfidence
Error Precursor Mitigations:

Stop work as needed and pause

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

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