Time / Date: 10/26/2022 7:17:00
JSP ID: 148
Scope of Work: Subcontractor to replace defective VFD DSC ON NEW AHU (77-AHU-039) at building 77 Roof
Work Order: 296430
Building:
Person in Charge: Christopher Nelson
Lead / Supervisor: Ramer, Robert
Logged Email: cnelson@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified:
List Other Participants: Alex Lopez
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: 72C2A
System Information Review: Panel Schedules, LOTO permit # 4707
Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
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.

Fill out jsp review Hazards and LOTO procedure/permit. Notify effective personnel. Switch LOTO ZVV and establish LOTO. Turn over LOTO to the RI. Contractor does the work after briefing and LOTO tags are applied

Control of Work Area

Minimum Approach Boundary: 42 inches
Barricade Tape / Attendant: Warning

Shock Risk Assessment

System Voltage: 277/480 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: .55 cal/cm^2 cal/cm2
Arc Flash Boundary: 12 inches
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: In room 105A
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Other side of building
Fire Extinguisher Location: 20ft from switch location
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location, Fall hazard, Work for ZVV on the roof could be slippery

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature: Assumptions, Complacency/overconfidence, Mind-set
Error Precursor Mitigations:

Stay alert and aware of surroundings

PPE Inspections

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