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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 11/15/2023 8:27:06
JSP ID: 1844
Scope of Work: Perform scheduled chiller maintenance

General Information

Work Order
344365
Building
30
Person in Charge
Larry antlers
Lead / Supervisor
Delgado, Alex
Logged Email
jwwalker@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Justin Walker
Other Participants
Plumbers
Affected Persons Notified
Yes

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
650a2a-1
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
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
Gather information and perform shock hazard and arc flash hazard assessment. And establish correct ppe. Contact user. Conduct a safety briefing. Perform switching. Apply loto and verify zvv. Perform maintenance tasks. Remove loto and restore power. Check operations and return equipment back to service.

Control of Work Area

Minimum Approach Boundary
42 inches
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
3.07 cal/cm2 cal/cm2
Arc Flash Boundary
29 inches
Working Distance
18 inches
Arc Flash PPE Level
2
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
700 vdc
Capacitor Total Stored Energy (Joules)
1600 joules
Discharge Wait Time (Minutes)
20 minutes

Emergency Response Plan

Nearest Landline Location
30 room 129
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
HVAC portable on sight
Fire Extinguisher Location
30 mechanical room
Contact Release Method Available and Tested
Upstream breaker or switch, Rescue hook, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Lookalike equipment

Error Precursors

Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
No current error precursors. Both technicians have performed this task multiple time and are comfortable with work.

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 Briefing

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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov