Time / Date: 3/11/2024 7:30:16
JSP ID: 2291
Scope of Work: Change breaker 4 in PNL 208A
Work Order: Training
Building: 75A
Person in Charge: Mike Rose
Lead / Supervisor: Other
Logged Email: MVR@lbl.gov
Division: Facilities
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: Ben C
List Other Participants: Class
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 208A
System Information Review: Arc Flash Labels
Control of Hazardous Energy: Simple LOTO
Equipment Condition: Properly installed, All doors and covers closed and fully latched, No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish.

Switch, loto, zvvv, chg brkr, install covers, reenergize

Control of Work Area

Minimum Approach Boundary: 59 in
Barricade Tape / Attendant: Attendant

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: 8.5 cal cal/cm2
Arc Flash Boundary: 59 in
Working Distance: 18 inches
Arc Flash PPE Level: 2+
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: B75
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path?
AED Location: S wall
Fire Extinguisher Location: Back door
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

Task Demands: Repetitive actions or monotony
Work Environment:
Individual Capabilities:
Human Nature: Complacency/overconfidence
Error Precursor Mitigations:

STAR method

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

208A 5.3 cal, 208v, 46 in afb wd 18 in

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