Time / Date: 11/8/2022 10:19:20
JSP ID: 205
Scope of Work: Loto out unit then replace faulty compressor (s).
Work Order: 299746
Building:
Person in Charge: Gerald Fowler
Lead / Supervisor: Delgado, Alex
Logged Email: gdfowler@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Justin Solis
List Other Participants: None
Affected Persons Notified: N/A
Switching: Hazardous Switching
Panel / Equipment ID: Mcc5A8A /46-ARU-005
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.

Recover refrigerant from unit. Loto out unit. Remove and replace faulty compressor(s) then evacuate unit and charge unit. Release Loto and start up unit.

Control of Work Area

Minimum Approach Boundary: 42 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: 5.12 cal cm 2 cal/cm2
Arc Flash Boundary: 37 inches
Working Distance: 18 inches
Arc Flash PPE Level: 2
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: Just inside building
Emergency Number to Call: 510-486-6999/7911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Lobby of building 64
Fire Extinguisher Location:
Contact release method available and tested: Upstream breaker or switch, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location, Insufficient/cramped/awkward space

Error Precursors

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

Remain mindful of actions and consequences.

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