Time / Date: 10/28/2022 8:25:33
JSP ID: 159
Scope of Work: Troubleshoot noisy ac unit
Work Order: 298882
Building:
Person in Charge: Antonio collado
Lead / Supervisor: Delgado, Alex
Logged Email: acollado@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: Gerald fowler
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: E35b15a1a/ 50b ac 008
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Simple LOTO
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.

Check power to uniy,Cycle unit on to verify noise loto and troubleshoot unit.

Control of Work Area

Minimum Approach Boundary: 106 inches
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: 29.5 cal/cm2
Arc Flash Boundary: 106 inches
Working Distance: 18 inches
Arc Flash PPE Level: 4
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: 50b next to elevator
Emergency Number to Call: 510486 6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: First floor next to elevator
Fire Extinguisher Location: Basement next to vault.
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting

Error Precursors

Task Demands: Critical steps or irreversible acts
Work Environment: Distractions/interruptions, Unexpected equipment conditions
Individual Capabilities: Indistinct problem-solving skills
Human Nature: Stress (limits attention), Assumptions, Mental shortcuts (biases)
Error Precursor Mitigations:

Provide more lighting in area

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