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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 1/4/2024 8:35:33
JSP ID: 2037
Scope of Work: Turn on lighting circuits that are not functioning as programmed

General Information

Work Order
360865
Building
15
Person in Charge
E combs
Lead / Supervisor
Combs, Everett
Logged Email
ccryken@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
Other Participants
Affected Persons Notified
N/A

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
Watt stopper LCP Bldg 15 2nd floor electrical room
System Information Review
☑ Finger safe
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
Equipment Condition
☑ Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish
Manually close relay switches in Lighting Control Panel

Control of Work Area

Minimum Approach Boundary
Not applicable
Barricade Tape / Attendant
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
Not applicable cal/cm2
Arc Flash Boundary
Not applicable
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
2nd floor copy room
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Bldg 15 1st floor lobby
Fire Extinguisher Location
2nd floor
Contact Release Method Available and Tested
Not applicable

Environmental Conditions

Does the environment present additional hazards that should be addressed?
None

Error Precursors

Task Demands
Time pressure (in a hurry)
Work Environment
Obscure electrical supplies or configurations
Individual Capabilities
Human Nature
Error Precursor Mitigations
Not applicable

PPE Inspections

☑ Safety glasses (ANSI Z87)

Notes / Other

LCP needs to be reprogrammed

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:
  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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov