Time / Date: 9/15/2023 12:21:03
JSP ID: 1553
Scope of Work: Perform PM on UPS 1 & 2 at B59
Work Order: NA
Building: B59
Person in Charge: Ernest Jew
Lead / Supervisor: Grounds, Jeff
Logged Email: ejew@lbl.gov
Division: Other
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Jeff Grounds
List Other Participants: Eaton technicians
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: UPS 1
System Information Review: Single Line Drawing, Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Complex LOTO w/ RI
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.

Set up orange warning tape and signage Notify the Control Room Take UPS out of ESS mode Put UPS into Bypass from UPS display Follow steps on red sign on UPS switchboard to Bypass UPS system and open circuit breakers Power off UPS 1&2 at UPS display Apply LOTO locks at UPS switchboard and battery cabinet circuit breakers Open UPS input cabinet and perform ZVV at UPS 1&2 Sign LOTO permit Perform LOTO briefing and have subcontractor sign LOTO permit Perform PM Notify Control Room that UPS will be coming back on line Release LOTO Follow steps on red sign on UPS to take UPS out of bypass at UPS switchboard Power on UPS 1&2 Take UPS 1&2 out of bypass at display Put UPS 1&2 in ESS mode Notify Control Room that work on UPS is complete Remove warning tape and signage

Control of Work Area

Minimum Approach Boundary: 100"
Barricade Tape / Attendant: Warning - Orange

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: 20 cal/cm2
Arc Flash Boundary: 100"
Working Distance: 18 inches
Arc Flash PPE Level: 3
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: Container office
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: portable unit in UPS room
Fire Extinguisher Location: UPS room
Contact release method available and tested: Rescue hook

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

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

Phone must be left on for On call duties, so phone calls may be an interruption

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:
  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