Time / Date: 10/21/2022 15:29:45
JSP ID: 129
Scope of Work: Put Final Power Amplifier under electrically safe conditions to troubleshoot. Switch breakers and verify capacitor voltage after 7 minutes.
Work Order:
Building:
Person in Charge: Taimoor Hassan
Lead / Supervisor: Other
Logged Email: hassan@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Ken Lambert
List Other Participants:
Affected Persons Notified:
Switching: Hazardous Switching
Panel / Equipment ID: A3120-CB3
System Information Review: Arc Flash Labels
Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
Equipment Condition: Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish.

Inform Control room and start applying LOTO to all CB as per R5G-1 procedure.

Control of Work Area

Minimum Approach Boundary: 65
Barricade Tape / Attendant: Caution

Shock Risk Assessment

System Voltage: 120/240 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
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: 9.25 cal/cm2
Arc Flash Boundary: 65
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 00

Capacitor Hazards

Capacitor Bus Voltage: 15.6
Capacitor total stored energy (joules): 409J
Discharge wait time (minutes): 7

Emergency Response Plan

Nearest Landline Location: outside Vault gate
Emergency Number to Call: 5104866999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 88 entrance
Fire Extinguisher Location: high bay
Contact release method available and tested: Upstream breaker or switch, Rescue hook, 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

PPE Inspections

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