|
Time / Date: 7/31/2023 9:37:41
|
JSP ID: 1320
|
|
Scope of Work: Will be replacing ballast
|
|
|
Work Order: W0335927
|
Building: 55
|
|
Person in Charge: Sayee Chea
|
Lead / Supervisor: Keusch, Justen
|
|
Logged Email: schea@lbl.gov
|
Division: Facilities
|
|
QEW Level: QEW 2
|
|
|
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
|
|
|
Second Person Requirement: Standby Person
|
|
|
Second Person Identified: Frank Hampton
|
|
|
List Other Participants:
|
|
|
Affected Persons Notified: Yes
|
|
|
Switching: Hazardous Switching
|
Panel / Equipment ID: 29A15A1A
|
|
System Information Review: Panel Schedules
|
|
|
Control of Hazardous Energy: Simple LOTO
|
|
|
Equipment Condition:
|
|
Sequence of Job Steps
|
List basic sequence of steps from start to finish.
|
Control of Work Area
|
Minimum Approach Boundary:
|
|
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: Yes
|
|
Voltage Glove Class: 0
|
|
Will any other part of the body enter the RAB: No
|
Arc Flash Risk Assessment
|
Incident Energy: 4.23 Cal cal/cm2
|
|
Arc Flash Boundary: 40 inches
|
|
Working Distance: 18 inches
|
|
Arc Flash PPE Level: Minimum PPE for Electrical Work
|
|
Incident Energy Reduction Measures: 0
|
Capacitor Hazards
|
Capacitor Bus Voltage:
|
|
Capacitor total stored energy (joules):
|
|
Discharge wait time (minutes):
|
Emergency Response Plan
|
Nearest Landline Location: 55 Room 110
|
|
Emergency Number to Call: 7911
|
|
Sufficient cell phone signal? Yes
|
|
Clear exit path? Yes
|
|
AED Location: Main lobby outside room 143
|
|
Fire Extinguisher Location: Hallway outside room 103
|
|
Contact release method available and tested: Voltage gloves
|
Environmental Conditions
|
Does the environment present additional hazards that should be addressed?
Heavy traffic |
Error Precursors
|
Task Demands:
|
|
Work Environment:
|
|
Individual Capabilities:
|
|
Human Nature:
|
|
Error Precursor Mitigations:
Review scope of work |
PPE Inspections
|
Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit, daily wear) including face shield, balaclava, hood., Hearing protection, 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:
Rev 2023.08.22.1 Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov |