Time / Date: 6/5/2023 8:22:47
JSP ID: 1133
Scope of Work: Pulling weeds
Work Order: W0327105
Building: Grizzly sub
Person in Charge: Colmenares
Lead / Supervisor: Cameron, Benjamin
Logged Email: jcolmenares@lbl.gov
Division: Facilities
QEW Level: QEW 3
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Safety Watch
Second Person Identified: Colmenares
List Other Participants: Huynh, Bedford, duconnun,Pham
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: N/A
System Information Review: Arc Flash Labels
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
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.

Brief, GroundTrucks

Control of Work Area

Minimum Approach Boundary: Stay clear of HV lines
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: 115,000 V ac
Limited Approach Boundary: 10 feet
Restricted Approach Boundary: None
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: Not Listed for pulling weeds cal/cm2
Arc Flash Boundary: 10 feet
Working Distance: Stay clear of HV LINES
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: Grizzlysub
Emergency Number to Call: 7911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: On Site
Fire Extinguisher Location: Sub station
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: Repetitive actions or monotony
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

None

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,
Insulated tools,
Multimeter and other electrical test instruments

Notes / Other

Use hard hats while in yard

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