Time / Date: 6/26/2024 7:33:03
JSP ID: 2701
Scope of Work: Cable Locating
Work Order: W0386885
Building: EMH 195
Person in Charge: Pica
Lead / Supervisor: Cameron, Benjamin
Logged Email: josephpica@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Safety Watch
Second Person Identified: Pica
List Other Participants: Locator Kevin Dobbs
Affected Persons Notified: N/A
Switching: No Switching Required
Panel / Equipment ID: EMH195 SWA6-circuits
System Information Review: Single Line Drawing, Butterflies
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish.

Clamp On Locate

Control of Work Area

Minimum Approach Boundary: Breach
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: Static
Limited Approach Boundary: Clamp On Hot Stick
Restricted Approach Boundary: Locating
Will the hands enter the RAB: No
Voltage Glove Class: Not Required
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: N/A cal/cm2
Arc Flash Boundary: Manhole Breach
Working Distance: Discharge
Arc Flash PPE Level: Minimum PPE for Electrical Work
Incident Energy Reduction Measures: Not Required

Capacitor Hazards

Capacitor Bus Voltage: None n/a
Capacitor total stored energy (joules): None n/a
Discharge wait time (minutes): None n/a

Emergency Response Plan

Nearest Landline Location: Cell Service
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Truck Carry
Fire Extinguisher Location: Rig Mount
Contact release method available and tested: Hot Stick

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Confined space, Potential

Error Precursors

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

ReBrief as Job Scope Changes

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
Non-melting footwear that fully covers the feet,
Insulated tools,
As Required

Notes / Other

No LOTO req’d

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