Time / Date: 8/31/2022 14:49:23
JSP ID: 2
Scope of Work: Testing
Work Order: 000000
Building:
Person in Charge: Dan Williams
Lead / Supervisor: Mike Rose
Logged Email: danwilliams@lbl.gov
Division: Facilities
QEW Level: QEW 1
Modes of Work: Mode 3 - Energized Repair Work
Second Person Requirement:
Second Person Identified:
List Other Participants:
Affected Persons Notified:
Switching:
Panel / Equipment ID: E46A35A1A15A
System Information Review:
Control of Hazardous Energy:
Equipment Condition: Properly maintained, Not energizing equipment for the first time, or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish.

Control of Work Area

Minimum Approach Boundary: 8 inches
Barricade Tape / Attendant: Caution

Shock Risk Assessment

System Voltage: 115,000 Vac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 inches
Will the hands enter the RAB: No
Voltage Glove Class: 0
Will any other part of the body enter the RAB: Yes

Arc Flash Risk Assessment

Incident Energy: 534 cal/cm2
Arc Flash Boundary:
Working Distance: 18 inches
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage:
Capacitor total stored energy (joules):
Discharge wait time (minutes): Option 1

Emergency Response Plan

Nearest Landline Location:
Emergency Number to Call:
Sufficient cell phone signal? No
Clear exit path? No
AED Location: n'a
Fire Extinguisher Location: over there
Contact release method available and tested: stick- wooden

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting, Wet location, Confined space, Insufficient/cramped/awkward space, Heavy traffic, Fall hazard, Lookalike equipment, Noisy environment, None

Error Precursors

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

Maybe we could include the possible mitigations

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