Time / Date: 6/22/2023 13:20:42
JSP ID: 1172
Scope of Work: Reset/Switch Tripped Circuit Breaker
Work Order: 331111
Building: 77
Person in Charge: Chris Nelson
Lead / Supervisor: Secheck, Stephen
Logged Email: cnelson@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Standby Person
Second Person Identified: Armand Uribe
List Other Participants: Armand Uribe
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: 85F
System Information Review: Arc Flash Labels
Control of Hazardous Energy: Exclusive Control of Plug
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.

Fill out JSP Use proper PPE Switch breaker check voltage at receptacle

Control of Work Area

Minimum Approach Boundary: 42 inches
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: No Shock Hazard Present
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
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: 4.58 cal/cm2 cal/cm2
Arc Flash Boundary: 42 inches
Working Distance: 18 inches
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: NA
Capacitor total stored energy (joules): NA
Discharge wait time (minutes): NA

Emergency Response Plan

Nearest Landline Location: In the office on other end of the room
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Main Entrance to building
Fire Extinguisher Location: In this room
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Be aware of surroundings lots of parts and carts in the area of panel

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature: Stress (limits attention)
Error Precursor Mitigations:

Be alert and aware at all times

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
Rubber insulating gloves and leather protectors,
Non-melting footwear that fully covers the feet

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