Time / Date: 7/25/2023 12:43:42
JSP ID: 1306
Scope of Work: Provide LOTO procedure for contractor to change ballast lamp on one of the fume hood.
Work Order:
Building: Bldg. 978/Rm. 4550
Person in Charge: Felipe Sanchez
Lead / Supervisor: Other
Logged Email: fbsanchez@lbl.gov
Division: Facilities
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Not Required
Second Person Identified:
List Other Participants:
Affected Persons Notified: N/A
Switching: No Switching Required
Panel / Equipment ID: n/a
System Information Review:
Control of Hazardous Energy: Simple LOTO
Equipment Condition:

Sequence of Job Steps

List basic sequence of steps from start to finish.

Cabinet was already shutoff upon arrival. Pulled out plug from outlet, checked voltage =118Vac. Applied LOTO hardware at power plug. Advised TSS technician that he can start troubleshooting. Ballast replaced with brand-new lamp. Technician tested equipment, working fine. Removed LOTO lock, equipment was left on off position. Lab customer was advised of the finished procedure.

Control of Work Area

Minimum Approach Boundary:
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: None
Restricted Approach Boundary: None
Will the hands enter the RAB: No
Voltage Glove Class:
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: n/a cal/cm2
Arc Flash Boundary: n/a
Working Distance: No Arc Flash Hazard Present
Arc Flash PPE Level: Minimum PPE for Electrical Work
Incident Energy Reduction Measures:

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: n/a
Emergency Number to Call: (510) 486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: n/a
Fire Extinguisher Location: Located on other side of concrete column.
Contact release method available and tested:

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:

n/a

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
Rubber insulating gloves and leather protectors,
Non-melting footwear that fully covers the feet,
Removal of conductive articles,
Insulated tools,
Multimeter and other electrical test instruments

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