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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 7/5/2023 11:05:16
JSP ID: 1213
Scope of Work: Opening handed panel 193A for visual inspection for information

General Information

Work Order
331068
Building
72
Person in Charge
Beau Erwin
Lead / Supervisor
Secheck, Stephen
Logged Email
jgerwin@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Safety Watch
Second Person Identified
Stephen Sechack
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
193A
System Information Review
☑ Arc Flash Labels
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
Equipment Condition
☑ Properly installed
☑ 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
Set up barrier. Put on appropriate PPE’s. Opening inch panel. Looking for information

Control of Work Area

Minimum Approach Boundary
Barricade Tape / Attendant
Danger - Red

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
00
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
5.79cal/cm2 cal/cm2
Arc Flash Boundary
43in
Working Distance
18 inches
Arc Flash PPE Level
2
Incident Energy Reduction Measures
00

Capacitor Hazards

Capacitor Bus Voltage
Capacitor Total Stored Energy (Joules)
Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location
Emergency Number to Call
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
72 hallway
Fire Extinguisher Location
Contact Release Method Available and Tested

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
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

Notes / Other

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:
  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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov