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Time / Date: 7/25/2023 13:47:53
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JSP ID: 1307
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Scope of Work: Broken circuit breaker replacement
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Work Order: n/a
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Building: Bldg. 2
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Person in Charge: Felipe Sanchez
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Lead / Supervisor: Other
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Logged Email: fbsanchez@lbl.gov
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Division: Facilities
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QEW Level: QEW 1
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Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
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Second Person Requirement: Standby Person
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Second Person Identified: Jaime Romo
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List Other Participants: n/a
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Affected Persons Notified: Yes
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Switching: Non-Hazardous Switching
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Panel / Equipment ID: n/a
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System Information Review: Operational/shutdown procedure for the equipment was provided by customer.customer.
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Control of Hazardous Energy: Cord & Plug LOTO
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Equipment Condition:
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Sequence of Job Steps
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List basic sequence of steps from start to finish.
This job was done on July 20, 20223. Upon arrival at the site, customer put his own LOTO on disconnects connected to main equipment. Advised him that we will replace his locks with our LOTO lock. Upon shutting down the equipment, measured ZVV, value = 244 Vac (proving unit). Measured zero values for the following (line -line terminals, line - ground terminals, neutral - ground terminals and line- neutral terminals). The new circuit breaker (to replace the broken handle) doesn't fit into the hole/slot. Customer was advised regarding the problem. Advised him that we'll research and purchase a new circuit breaker. QEW/LOTO locks were removed, disconnects were turned on and equipment was live for operation. |
Control of Work Area
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Minimum Approach Boundary:
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Barricade Tape / Attendant:
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Shock Risk Assessment
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System Voltage: 120/240 V ac
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Limited Approach Boundary: None
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Restricted Approach Boundary: None
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Will the hands enter the RAB: No
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Voltage Glove Class: 00
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Will any other part of the body enter the RAB: No
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Arc Flash Risk Assessment
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Incident Energy: No access/locked on electrical panel. cal/cm2
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Arc Flash Boundary: n/a
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Working Distance: No Arc Flash Hazard Present
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Arc Flash PPE Level: Minimum PPE for Electrical Work
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Incident Energy Reduction Measures: 00
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Capacitor Hazards
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Capacitor Bus Voltage:
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Capacitor total stored energy (joules):
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Discharge wait time (minutes):
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Emergency Response Plan
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Nearest Landline Location: inside the laboratory room
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Emergency Number to Call: (510) 486-6999
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Sufficient cell phone signal? Yes
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Clear exit path? Yes
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AED Location: outside of room
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Fire Extinguisher Location: outside of hallway
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Contact release method available and tested:
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Environmental Conditions
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Does the environment present additional hazards that should be addressed?
Confined space, Insufficient/cramped/awkward space |
Error Precursors
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Task Demands:
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Work Environment:
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Individual Capabilities:
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Human Nature:
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Error Precursor Mitigations:
n/a |
PPE Inspections
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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
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Perform Job Breifing
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PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.
A Job Briefing at a minimum must include:
Rev 2023.08.22.1 Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov |