Time / Date: 7/14/2023 12:13:24
JSP ID: 1263
Scope of Work: Inspection and maintenance of Trim Coil 16, 17 power suppies
Work Order: N/A
Building: B88
Person in Charge: Kenneth Lambert
Lead / Supervisor: Other
Logged Email: klambert@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: Taimoor Hassan
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: BE240
System Information Review: Arc Flash Labels, Dwg 8W3695
Control of Hazardous Energy: Complex LOTO w/ RI
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.

Perform LOTO procedure P4E-6 and -7, perform inspection of trim coil 16 and 17 power supply, perform any required maintenance/repairs that might be required, secure the area, release the LOTO, check operation of the power supply.

Control of Work Area

Minimum Approach Boundary: 42
Barricade Tape / Attendant: Notice - Blue

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: 9.6 cal/cm2
Arc Flash Boundary: 65
Working Distance: 18 inches
Arc Flash PPE Level: 2+
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: Control room
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Front lobby of B88
Fire Extinguisher Location: Next to stairs on transformer pad and by the control room
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting, Confined space, PCB hazard

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

No mitigations

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,
PPE for PCB work

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