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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 7/17/2023 8:05:47
JSP ID: 1265
Scope of Work: LOTO/ ZVV, LOTO at pnl 304a1A ckt 9, then ZVV at pnl 283A to revoke existing wireway to accommodate new equipment

General Information

Work Order
320313
Building
Bldg6
Person in Charge
E combs
Lead / Supervisor
Keusch, Justen
Logged Email
ccryken@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Greg Neidiger
Other Participants
Affected Persons Notified

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
304A1A & 383A
System Information Review
☑ Panel Schedules
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
Open breaker and establish LOTO. ZVV at pnl 283A. Perform work. Have work inspected and release loto

Control of Work Area

Minimum Approach Boundary
83 inches
Barricade Tape / Attendant
Warning - Orange

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
3 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
1.2cal cal/cm2
Arc Flash Boundary
83
Working Distance
18 inches
Arc Flash PPE Level
4
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
Beamline 10
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Bldg 6 lobby
Fire Extinguisher Location
Column 3
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
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
None identified

PPE Inspections

☑ Safety glasses (ANSI Z87)

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