QEW 1 / 2 / 3 Job Safety Plan
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Time / Date:
12/21/2023 8:27:19
JSP ID:
2009
Scope of Work:
Trouble shoot light issue in room 15-0217
General Information
Work Order
359879
Building
15-0217
Person in Charge
C.ryken
Lead / Supervisor
Combs, Everett
Logged Email
ccryken@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
Other Participants
Affected Persons Notified
Yes
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
Watt stopper LCP
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
Equipment Condition
☑
Sequence of Job Steps
List basic sequence of steps from start to finish
Control of Work Area
Minimum Approach Boundary
Barricade Tape / Attendant
Shock Risk Assessment
System Voltage
No Shock Hazard Present
Limited Approach Boundary
None
Restricted Approach Boundary
None
Will the hands enter the RAB
No
Voltage Glove Class
Not Required
Will any other part of the body enter the RAB
No
Arc Flash Risk Assessment
Incident Energy
0 cal/cm2
Arc Flash Boundary
42 inches
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
Minimum PPE for Electrical Work
Incident Energy Reduction Measures
Not Required
Capacitor Hazards
Capacitor Bus Voltage
Capacitor Total Stored Energy (Joules)
Discharge Wait Time (Minutes)
Emergency Response Plan
Nearest Landline Location
Emergency Number to Call
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Bldg15 lobby
Fire Extinguisher Location
Contact Release Method Available and Tested
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
☑ Safety glasses (ANSI Z87)
☑ Arc-rated clothing (flash suit
☑ daily wear) including face shield
☑ balaclava
☑ hood.
☑ Removal of conductive articles
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
