Scope of Work:Replace like for like 20A GFI outlets in lab 157
General Information
Work Order
379314,382251 Both WO for same lab and fed out of same panel
Building
70
Person in Charge
Shane Miller
Lead / Supervisor
Secheck, Stephen
Logged Email
spmiller@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Alex Lopez
Other Participants
Affected Persons Notified
Yes
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
30A3A5B27A
System Information Review
☑ Panel Schedules ☑ Arc Flash Labels
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑ Properly installed ☑ 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
Dawn the proper PPE, LOTO, ZVV replace outlet. Release LOTO and test new outlet
Control of Work Area
Minimum Approach Boundary
42"
Barricade Tape / Attendant
Attendant
Shock Risk Assessment
System Voltage
120/208 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
8.34cal/cm2 cal/cm2
Arc Flash Boundary
61"
Working Distance
18 inches
Arc Flash PPE Level
Minimum PPE for Electrical Work
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
Lab 157
Emergency Number to Call
x6999
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
in hallway about 40' away
Fire Extinguisher Location
in hallway outside 157
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
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)
