Time / Date: 8/30/2023 11:33:43
JSP ID: 1476
Scope of Work: Requested by customer to check AC and DC voltages readings for their equipment.
Work Order: n/a
Building: Bldg. # 2
Person in Charge: FELIPE SANCHEZ
Lead / Supervisor: Other
Logged Email: fbsanchez@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Not Required
Second Person Identified:
List Other Participants: Manufacturer's technician on site including the customer/user.
Affected Persons Notified: N/A
Switching: Hazardous Switching
Panel / Equipment ID: n/a
System Information Review:
Control of Hazardous Energy: Exclusive Control of Plug
Equipment Condition: Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish.

Customer requested to check AC/DC voltages on their equipment, monitored VAC input = 123.3Vac, DC voltages (24Vdc, -15Vdc, +15Vdc) on chamber #3. Frequency = 60Hz. Not much space at the back of equipment.

Control of Work Area

Minimum Approach Boundary:
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 feet, 6 inches
Will the hands enter the RAB: Yes
Voltage Glove Class: 00
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: 36 inches
Arc Flash PPE Level: Minimum PPE for Electrical Work
Incident Energy Reduction Measures: 00

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: Inside the room.
Emergency Number to Call: 510 486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Outside of hallway
Fire Extinguisher Location: Located at the hallway
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting, Confined space, Insufficient/cramped/awkward space, Noisy environment

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Cramped space at the back of equipment.

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,
Multimeter and other electrical test instruments

Notes / Other

n/a

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