Time / Date: 6/5/2024 13:17:30
JSP ID: 2649
Scope of Work: Replace defective air valve and power cord on autoclave unit.
Work Order: n/a
Building: Bldg. 70A, Rm. 4463
Person in Charge: Felipe Sanchez
Lead / Supervisor: Other
Logged Email: fbsanchez@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification, Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Not Required
Second Person Identified: n/a
List Other Participants: n/a
Affected Persons Notified: N/A
Switching: Non-Hazardous Switching
Panel / Equipment ID: n/a
System Information Review: n/a
Control of Hazardous Energy: Cord & Plug LOTO
Equipment Condition: Not energizing equipment for the first time, or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish.

Autoclave unit had been non-operational for months now. Checked voltage (122.2Vac). Contractor replaced defective power cord and plug. Replaced broken valve and found solid residue inside. Cleaned with tap water. Checked also the rest of the copper tubings with the same solid residue inside. Powered unit for calibration. Unit was operational and turned over to customer/user.

Control of Work Area

Minimum Approach Boundary: n/a
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: None
Restricted Approach Boundary: None
Will the hands enter the RAB: No
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: n/a cal/cm2
Arc Flash Boundary: n/a
Working Distance: 36 inches
Arc Flash PPE Level: Minimum PPE for Electrical Work
Incident Energy Reduction Measures: 0

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: inside room
Emergency Number to Call: (510) 486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: inside room
Fire Extinguisher Location: inside room
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting

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 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