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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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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

General Information

Work Order
N/A
Building
59
Person in Charge
Jeff Grounds
Lead / Supervisor
Grounds, Jeff
Logged Email
jtgrounds@lbl.gov
Division
Comp Sci

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Jeff Grounds
Other Participants
HVAC Controls, Sunbelt Controls
Affected Persons Notified
Yes

System / Equipment

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 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