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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 3/27/2024 7:22:29
JSP ID: 2371
Scope of Work: Contractor Support

General Information

Work Order
W0373266
Building
36
Person in Charge
Avery Turner
Lead / Supervisor
Cameron, Benjamin
Logged Email
avery.turner08@gmail.com
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
none
Other Participants
contractor
Affected Persons Notified
N/A

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
n/A
System Information Review
☑
Control of Hazardous Energy
Exclusive Control of Plug
Equipment Condition
☑ Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish
Hold safety meeting with contractor.

Control of Work Area

Minimum Approach Boundary
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
above greater then ten feet
Limited Approach Boundary
10 feet
Restricted Approach Boundary
120
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
none cal/cm2
Arc Flash Boundary
none
Working Distance
120 inches
Arc Flash PPE Level
2
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
none
Capacitor Total Stored Energy (Joules)
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
No
AED Location
yes
Fire Extinguisher Location
yes
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)
☑ safety glasses

Notes / Other

none

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:
  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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov