Scope of Work:We are installing our gold lock and lockout to a 3 pole breaker controlling a disconnect. We are going to close the 3 pole breaker and ZVV the disconnect that was installed by cal neva. After ZVV is done we will hang out gold lock and take out lotto off.
General Information
Work Order
330919
Building
50b
Person in Charge
Armand uribe
Lead / Supervisor
Ramer, Robert
Logged Email
Auribe@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 1
Second Person Requirement
Standby Person
Second Person Identified
Jarrod tissot
Other Participants
Cal neva
Affected Persons Notified
N/A
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
38A4B2A
System Information Review
☑ Panel Schedules ☑ Arc Flash Labels
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
Inspect PPE, JSP, install gold lock for 3 pole breaker. Close the breaker. Lotto 3 pole breaker. ZVV disconnect. Hang gold lock and take off out lotto lock.
Control of Work Area
Minimum Approach Boundary
18”
Barricade Tape / Attendant
Attendant
Shock Risk Assessment
System Voltage
120/208 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
0.43 cal/cm2
Arc Flash Boundary
10”
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
Minimum PPE for Electrical Work
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
6th floor
Emergency Number to Call
925-724-3900
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
6th floor hallway
Fire Extinguisher Location
6th floor hallway
Contact Release Method Available and Tested
Upstream breaker or switch, Voltage gloves
Environmental Conditions
Does the environment present additional hazards that should be addressed?
