QEW 1 / 2 / 3 Job Safety Plan

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Time / Date: 12/15/2023 10:27:27

JSP ID: 1986

Scope of Work: Relocate a 3 phase 208 twist lock receptacle from outside the building to inside the building.

General Information

Work Order

359280

Building

Person in Charge

Anthony Pilz

Lead / Supervisor

Secheck, Stephen

Logged Email

apilz@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 1 - LOTO & Zero Voltage Verification

QEW Level

QEW 2

Second Person Requirement

Standby Person

Second Person Identified

Shane Miller

Other Participants

Affected Persons Notified

Yes

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

86A28A

System Information Review

☑ Panel Schedules

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

Don PPE LOTO and ZVV Take receptacle and box out of the shed Relocate to wall before the penetration. Release LOTO ReEnergize

Control of Work Area

Minimum Approach Boundary

71in

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

Voltage Glove Class

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

14.2 cal/cm2

Arc Flash Boundary

71 inches

Working Distance

No Arc Flash Hazard Present

Arc Flash PPE Level

Minimum PPE for Electrical Work

Incident Energy Reduction Measures

Capacitor Hazards

Capacitor Bus Voltage

Capacitor Total Stored Energy (Joules)

Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location

B77-242

Emergency Number to Call

x6999 / 911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

B77-239

Fire Extinguisher Location

B77-242

Contact Release Method Available and Tested

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

Task Demands

Critical steps or irreversible acts

Work Environment

Distractions/interruptions

Individual Capabilities

Human Nature

Mind-set

Error Precursor Mitigations

Take our time and no rush

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan