Time / Date: 6/29/2024 12:54:19
JSP ID: 2711
Scope of Work: Take Photos (spare breakers) to Support future Panel Work
Work Order: W0388956
Building: 69
Person in Charge: Pica
Lead / Supervisor: Cameron, Benjamin
Logged Email: josephpica@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: A J Turner
List Other Participants: None
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: 217A1A1A spare circuits
System Information Review: Single Line Drawing, Panel Schedules, Arc Flash Labels, Work Order Request
Control of Hazardous Energy: Complex LOTO w/ RI
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.

LOTO established ZVV Photos and Panel Schedule Return to Service

Control of Work Area

Minimum Approach Boundary: 42”
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: 277/480 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 inches
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: 3.15cal/cm^2 cal/cm2
Arc Flash Boundary: 33”
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: No Capacitor
Capacitor total stored energy (joules): No Capacitor
Discharge wait time (minutes): No Capacitor

Emergency Response Plan

Nearest Landline Location: Cell Phone
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Truck
Fire Extinguisher Location: Wall Mount
Contact release method available and tested: Within Established LOTO

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:

Three Way Communication Work Lights

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
Hearing protection,
Non-melting footwear that fully covers the feet,
Removal of conductive articles,
Multimeter and other electrical test instruments

Notes / Other

Visual Inspection

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