Time / Date: 2/26/2024 9:15:47
JSP ID: 2259
Scope of Work: Release LOTO upon panel 302A1A (storage ring pit)
Work Order: 362336
Building: 6
Person in Charge: E combs
Lead / Supervisor: Combs, Everett
Logged Email: ccryken@lbl.gov
Division: ALS
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Safety Watch
Second Person Identified: Christopher Nelson
List Other Participants: Christopher Ryken
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 302A1A
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.

Ensure it is safe to re energize. Notify persons affected. Continue with re energization

Control of Work Area

Minimum Approach Boundary: 6’ 4”
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: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 12.6 cal/cm2
Arc Flash Boundary: 6’ 4”
Working Distance: 18 inches
Arc Flash PPE Level: 3
Incident Energy Reduction Measures: 00

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: Desk at booster ring entrance on storage ring side
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Control room
Fire Extinguisher Location: Next to door 2 on storage ring side of SR pit
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment, Noisy environment

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature: Assumptions, Mind-set, Mental shortcuts (biases)
Error Precursor Mitigations:

Assure that re energization is appropriate

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

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