Time / Date: 5/29/2024 10:08:14
JSP ID: 2623
Scope of Work: Perform LOTO and ZVV to replace broken circuit breaker.
Work Order: Complex LOTO Procedure # 299
Building: Bldg. 2/Room 137
Person in Charge: Felipe Sanchez
Lead / Supervisor: Other
Logged Email: fbsanchez@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Not Required
Second Person Identified: n/a
List Other Participants: n/a
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: Panel 243A/Circuit 10
System Information Review:
Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
Equipment Condition: Properly installed, Properly maintained, All doors and covers closed and fully latched, No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish.

Equipment was shutdown by customer. Main switch was provided with LOTO, ZVV was checked behind main equipment (124Vac). Defective broken circuit breaker was replaced with a new unit. LOTO was removed from main cut-off switch. Unit was powered up by customer.

Control of Work Area

Minimum Approach Boundary: 12
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: 1.2 cal/cm2
Arc Flash Boundary: 1.2
Working Distance: 36 inches
Arc Flash PPE Level: Minimum PPE for Electrical Work
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: Located inside room
Emergency Number to Call: (510) 486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: AED is located outside of main door.
Fire Extinguisher Location: Located outside of main door.
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting, Insufficient/cramped/awkward space

Error Precursors

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

yes

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 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