Time / Date: 1/16/2024 7:21:05
JSP ID: 2075
Scope of Work: Notify EM’s to be there with als admin lock Switch 302A1A Ckt 4 LOTO and ZVV L103 after ZVV release our LOTO for the ZVV leave ZVV equipment under admin LOTO
Work Order: 3262336
Building: 6 ALS
Person in Charge: Christopher Nelson
Lead / Supervisor: Combs, Everett
Logged Email: cnelson@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Safety Watch
Second Person Identified: David Davis
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 302A1A ckt 4 L103
System Information Review: Panel Schedules
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.

Fill out JSP inspect and select proper PPE And tools and equipment Switch LOTO ZVV

Control of Work Area

Minimum Approach Boundary: 76”
Barricade Tape / Attendant: Danger - Red

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: 12.6 cal/cm2
Arc Flash Boundary: 76”
Working Distance: 18 inches
Arc Flash PPE Level: 3
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: Within 10’
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Lobby of b 15
Fire Extinguisher Location: Within 20’
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment, Noisy environment

Error Precursors

Task Demands: Time pressure (in a hurry), Simultaneous or multiple tasks, Repetitive actions or monotony
Work Environment: Distractions/interruptions
Individual Capabilities:
Human Nature: Stress (limits attention), Mind-set
Error Precursor Mitigations:

Keep focused and alert while performing work

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
Hearing protection,
Rubber insulating gloves and leather protectors,
Non-melting footwear that fully covers the feet,
Removal of conductive articles,
Insulated tools,
Multimeter and other electrical test instruments

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