☑ Mode 0 - Electrically Safe Work Condition ☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Frank Hampton
Other Participants
Affected Persons Notified
Yes
System / Equipment
Switching
Hazardous Switching
Panel / Equipment ID
E460A5A1A22A16A
System Information Review
☑ Panel Schedules
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
Identified panel/breaker, notified affected people, identified PPE, inspects PPE, Gloves, Tools and apply LOTO, Performed ZVV, carried out work, brought power back on after informing customers
Control of Work Area
Minimum Approach Boundary
Barricade Tape / Attendant
Warning - Orange, Attendant
Shock Risk Assessment
System Voltage
277/480 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
3 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
15.2 cal/cm2
Arc Flash Boundary
73 inches
Working Distance
18 inches
Arc Flash PPE Level
1
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
Room 320
Emergency Number to Call
7911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Lobby
Fire Extinguisher Location
Hallway
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
Review scope of work
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
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:
Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
