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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 7/3/2024 10:00:57
JSP ID: 2727
Scope of Work: Remove circuits from furniture on second floor cubicals.

General Information

Work Order
367360
Building
ALS 6
Person in Charge
Christopher Nelson
Lead / Supervisor
Combs, Everett
Logged Email
cnelson@lbl.gov
Division
ALS

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Robert Ralph
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
347A28A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
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
☑ Not energizing equipment for the first time
☑ or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish
Briefing with lead fill out JSP use PPE and LOTO fill out als complex LOTO procedure form. Briefing with all parties before switching and LOTO. Switch the circuits on the LOTO procedure. Lock out tag out and then ZVV if there are unknown circuits still on during ZVV stop work and contact the lead. If all circuits are off proceed with disconnecting circuits from the cubical. When it is in electrically safe condition remove LOTO and re energize or leave off and replace LOTO locks with admin locks.

Control of Work Area

Minimum Approach Boundary
42”
Barricade Tape / Attendant
Warning - Orange

Shock Risk Assessment

System Voltage
120 Vac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
12 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
.13 cal/cm^2 cal/cm2
Arc Flash Boundary
5 inches
Working Distance
18 inches
Arc Flash PPE Level
2
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
Na
Capacitor Total Stored Energy (Joules)
Na
Discharge Wait Time (Minutes)
Na

Emergency Response Plan

Nearest Landline Location
Room 2101 copy room next to the work
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Just downstairs in lobby
Fire Extinguisher Location
In room of the ZVV work
Contact Release Method Available and Tested
Upstream breaker or switch, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
None

Error Precursors

Task Demands
Time pressure (in a hurry)
Work Environment
Distractions/interruptions
Individual Capabilities
Imprecise communication habits
Human Nature
Habit patterns
Error Precursor Mitigations
Be aware and in communication with the second person at all times keep a level head and keep on the task don’t think about the early release and holiday

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
☑ Non-melting footwear that fully covers the feet
☑ Removal of conductive articles
☑ Insulated tools
☑ Multimeter and other electrical test instruments
☑ Heavy duty leather cloves

Notes / Other

Be safe

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:
  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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov