Time / Date: 3/15/2024 9:53:58
JSP ID: 2318
Scope of Work: LOTO and ZVV for CHA evaporator equipment for repair/maintenance work of vacuum unit.
Work Order: n/a
Building: Bldg. 2
Person in Charge: Felipe Sanchez
Lead / Supervisor: Other
Logged Email: fbsanchez@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Not Required
Second Person Identified: n/a
List Other Participants: n/a
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: n/a
System Information Review:
Control of Hazardous Energy: Cord & Plug LOTO
Equipment Condition: Properly installed, Properly maintained, All doors and covers closed and fully latched

Sequence of Job Steps

List basic sequence of steps from start to finish.

Turn off power switches for main power and equipment located behind the main equipment. Applied LOTO locks on the unit. Performed zero voltage verification procedure at the back of equipment (proving unit = 244.2Vac, outlet receptacle = 0 values). Customer was advised about the test values.

Control of Work Area

Minimum Approach Boundary: n/a
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: 120/240 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: No
Voltage Glove Class: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: n/a cal/cm2
Arc Flash Boundary: n/a
Working Distance: No Arc Flash Hazard Present
Arc Flash PPE Level: Minimum PPE for Electrical Work
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: inside the room
Emergency Number to Call: (510) 486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: next room
Fire Extinguisher Location: inside room
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting, Confined space, Insufficient/cramped/awkward space, Noisy environment

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

n/a

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
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