Time / Date: 7/24/2023 9:32:32
JSP ID: 1296
Scope of Work: Releasing gold lock.
Work Order: 334168
Building: 50b
Person in Charge: Armand Uribe
Lead / Supervisor: Ramer, Robert
Logged Email: auribe@lbl.gov
Division: Facilities
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Standby Person
Second Person Identified: Jarrod Tissot
List Other Participants: Cal neva
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: 38A4B
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.

PPE, Release gold lock

Control of Work Area

Minimum Approach Boundary: 42”
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: No Shock Hazard Present
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: 0.058 cal/cm2
Arc Flash Boundary: 12”
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 hallway
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: 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

Safety glasses (ANSI Z87),
Rubber insulating gloves and leather protectors

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