Time / Date: 11/7/2023 11:16:45
JSP ID: 1815
Scope of Work: Trace out and test abandoned 12 Kv cable
Work Order: W0349790
Building: Building 70a
Person in Charge: Colmenares
Lead / Supervisor: Cameron, Benjamin
Logged Email: jcolmenares@lbl.gov
Division: Facilities
QEW Level: QEW 3
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Safety Watch
Second Person Identified: Pica
List Other Participants: Kevin
Affected Persons Notified: N/A
Switching: No Switching Required
Panel / Equipment ID: Dead end cables behind 70A-ADF-002
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Properly installed, 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.

Brief prox testing escort tracer person Kevin

Control of Work Area

Minimum Approach Boundary: 65 inch
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: Possible 480 or 12 kv
Limited Approach Boundary: 65 inch
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: Yes
Voltage Glove Class: 2
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 3.18 cal cal/cm2
Arc Flash Boundary: 65 inch
Working Distance: 24 inches
Arc Flash PPE Level: 4
Incident Energy Reduction Measures: 2

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: None
Emergency Number to Call: 7922
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: On site
Fire Extinguisher Location: None in pit area
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

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

None

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

None

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