Time / Date: 11/3/2022 12:06:36
JSP ID: 186
Scope of Work: Troubleshoot 37 Gl 101 Job briefing
Work Order: WO0297223
Building:
Person in Charge: Ben Cameron
Lead / Supervisor: Cameron, Benjamin
Logged Email: avery.turner08@gmail.com
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Safety Watch
Second Person Identified: Avery Turner
List Other Participants: PMT
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: 37-FL-101
System Information Review: Arc Flash Labels
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Properly maintained

Sequence of Job Steps

List basic sequence of steps from start to finish.

Troubleshoot

Control of Work Area

Minimum Approach Boundary: 42
Barricade Tape / Attendant: Danger - Red

Shock Risk Assessment

System Voltage: 277/480 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 feet, 6 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: 0.19 cal/cm2
Arc Flash Boundary: 7 inches
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: None
Capacitor total stored energy (joules): None
Discharge wait time (minutes): None

Emergency Response Plan

Nearest Landline Location: Cell phone with a good signal
Emergency Number to Call: 7911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: On site
Fire Extinguisher Location: Not out side
Contact release method available and tested: Upstream breaker or switch

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

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