Time / Date: 11/7/2022 8:54:19
JSP ID: 199
Scope of Work: Subcontractor to Rewire and test the low water cut off switch for the new boiler (66-BR-04) LBL LOTO support
Work Order: 301457
Building:
Person in Charge: Christopher Nelson
Lead / Supervisor: Ramer, Robert
Logged Email: cnelson@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Alex lopez
List Other Participants: Alex lopez
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: Disconnect 66-BR-004
System Information Review: 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.

Review LOTO permit procedure LP-4775 briefing fill out jsp Inspect select proper pipe switch LOTO ZVV hang gold HEC lock turnover lotto to The RI contractor does work. Release LOTO and re energize test for normal operation

Control of Work Area

Minimum Approach Boundary: 69 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: 18.1 cal/cm^2 cal/cm2
Arc Flash Boundary: 69inches
Working Distance: 18 inches
Arc Flash PPE Level: 4
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: Real room area 66
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Lobby
Fire Extinguisher Location: Next room
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Noisy environment

Error Precursors

Task Demands: Time pressure (in a hurry)
Work Environment: Distractions/interruptions
Individual Capabilities:
Human Nature: Stress (limits attention)
Error Precursor Mitigations:

Don’t be rushed be alert don’t get complacent

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