Time / Date: 3/27/2024 7:06:46
JSP ID: 2369
Scope of Work: support contractor spraying weed killer
Work Order: W0373266
Building: 36
Person in Charge: Avery Turner
Lead / Supervisor: Cameron, Benjamin
Logged Email: avery.turner08@gmail.com
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Not Required
Second Person Identified: none
List Other Participants: weed removal contractors
Affected Persons Notified: N/A
Switching: No Switching Required
Panel / Equipment ID: none
System Information Review:
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish.

Hold a tailgate meeting to in form the contractors on our safety procedures.

Control of Work Area

Minimum Approach Boundary: 120 inches
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: spraying weeds
Limited Approach Boundary: 10 feet
Restricted Approach Boundary: 10 feet
Will the hands enter the RAB: No
Voltage Glove Class: Not Required
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: none cal/cm2
Arc Flash Boundary: none
Working Distance: 10 feet
Arc Flash PPE Level: 2+
Incident Energy Reduction Measures: Not Required

Capacitor Hazards

Capacitor Bus Voltage: none
Capacitor total stored energy (joules): none
Discharge wait time (minutes): none

Emergency Response Plan

Nearest Landline Location: building 36
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location:
Fire Extinguisher Location: yes in building 36
Contact release method available and tested: Voltage gloves

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

none

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