Time / Date: 4/4/2024 13:21:47
JSP ID: 2409
Scope of Work: Install missing cover on existing jbox
Work Order: 376445
Building: 43-199
Person in Charge: Shane Miller
Lead / Supervisor: Secheck, Stephen
Logged Email: spmiller@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Standby Person
Second Person Identified: Anthony pilz
List Other Participants: Steve Sechak
Affected Persons Notified: N/A
Switching: No Switching Required
Panel / Equipment ID: ?
System Information Review: Unlabeled jbox
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition:

Sequence of Job Steps

List basic sequence of steps from start to finish.

Wrap jbox with blanket and make electrically safe

Control of Work Area

Minimum Approach Boundary: 42”
Barricade Tape / Attendant: Danger - Red

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: No
Voltage Glove Class: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: Ukn cal/cm2
Arc Flash Boundary: 8’
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 00

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: Building 43
Emergency Number to Call: X6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Building 43
Fire Extinguisher Location: Building 43
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location

Error Precursors

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

Wet location

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

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