Scope of Work:Put the FA dialer and media converter on normal power
General Information
Work Order
W0363761
Building
70
Person in Charge
Noel Cuffee
Lead / Supervisor
Other
Logged Email
eacuffee@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 0 - Electrically Safe Work Condition ☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 1
Second Person Requirement
Not Required
Second Person Identified
N/A
Other Participants
N/A
Affected Persons Notified
N/A
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
System 3
System Information Review
☑ Panel Schedules ☑ 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
ZVV normal power wires, unplug temp power cord and land normal power wires to devices, remove loto lock on normalbreaker and energize breaker. ZVV incoming power to devices.
Control of Work Area
Minimum Approach Boundary
Barricade Tape / Attendant
Warning - Orange
Shock Risk Assessment
System Voltage
120 Vac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
3 inches
Will the hands enter the RAB
No
Voltage Glove Class
0
Will any other part of the body enter the RAB
No
Arc Flash Risk Assessment
Incident Energy
4 cal cal/cm2
Arc Flash Boundary
None
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
Minimum PPE for Electrical Work
Incident Energy Reduction Measures
0
Capacitor Hazards
Capacitor Bus Voltage
N/A
Capacitor Total Stored Energy (Joules)
N/A
Discharge Wait Time (Minutes)
N/A
Emergency Response Plan
Nearest Landline Location
Inside the FA elect room
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
1st floor entry to B70
Fire Extinguisher Location
Inside FA elect rm
Contact Release Method Available and Tested
N/A
Environmental Conditions
Does the environment present additional hazards that should be addressed?
Wet location
Error Precursors
Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
N/A
PPE Inspections
☑ Safety glasses (ANSI Z87) ☑ 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
N/A
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:
Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
