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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 5/21/2024 9:32:09
JSP ID: 2598
Scope of Work: For circuit breaker # 16 (260A29A-16) : Needs to apply LOTO/ZVV for this circuit #16.

General Information

Work Order
n/a
Building
Bldg. 58/Electronic shop
Person in Charge
Felipe Sanchez
Lead / Supervisor
Other
Logged Email
fbsanchez@lbl.gov
Division
Other

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 1
Second Person Requirement
Safety Watch
Second Person Identified
Jaime Romo
Other Participants
n/a
Affected Persons Notified
Yes

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
Panel # 260A29A-16
System Information Review
☑ Arc Flash Labels
☑ This panel/sticker was last checked by FAC ENG on 09/08/21
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
Check voltage at outlets = 123.5Vac. Applied LOTO to circuit breaker # 16. Checked ZVV at outlet again value = 0. Uninstalled outlets at the back of working cabinets. These outlets needs to be disconnected to clear space moving testing cabinets inside shop 58.

Control of Work Area

Minimum Approach Boundary
36 in.
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
12 inches
Will the hands enter the RAB
No
Voltage Glove Class
1
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
11.3 cal/cm cal/cm2
Arc Flash Boundary
62 in.
Working Distance
36 inches
Arc Flash PPE Level
1
Incident Energy Reduction Measures
1

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
(510) 486-5531
Emergency Number to Call
(510) 486-5531
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Located inside bldg. 58/electronic shop
Fire Extinguisher Location
Located inside bldg. 58/electronic shop
Contact Release Method Available and Tested
Upstream breaker or switch

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
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

n/a

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