Time / Date: 1/20/2024 11:23:04
JSP ID: 2109
Scope of Work: HVAC Controls to Install 120V disconnects for chilled water valves AHU's 17,18,19,20
Work Order: N/A
Building: 59
Person in Charge: Jeff Grounds
Lead / Supervisor: Grounds, Jeff
Logged Email: jtgrounds@lbl.gov
Division: Comp Sci
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: Jeff Grounds
List Other Participants: HVAC Controls, Sunbelt Controls
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: Panel 694
System Information Review: Single Line Drawing, Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Complex LOTO w/ RI
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.

Perform job and LOTO briefing with contractor NERSC QEW2 to LOTO Panel 694 at 480V disconnect ZVV at Panel 694 (120/208V panel) ZVV at PNL 694 branch circuit junction boxes at AHU's prior to starting work Re work conduit, wire and add disconnects Perform re energization briefing Remove LOTO and re energize Panel 694 at 480V disconnect Verify operation of associated equipment Perform post job briefing

Control of Work Area

Minimum Approach Boundary: 20"
Barricade Tape / Attendant: Warning - Orange

Shock Risk Assessment

System Voltage: 120/208 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: Yes
Voltage Glove Class: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 1.38 ca/cm2 cal/cm2
Arc Flash Boundary: 20"
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 00

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: Jeff Grounds Office
Emergency Number to Call: X6999 0r (510) 486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Jeff Grounds Office
Fire Extinguisher Location: Adjacent columns in room 1201A, UPS room
Contact release method available and tested: Rescue hook

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.,
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