QEW 1 / 2 / 3 Job Safety Plan

General Information

Work Order

388997

Building

55

Person in Charge

Alejandro Lopez

Lead / Supervisor

Ramer, Robert

Logged Email

Alopez2@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 1 - LOTO & Zero Voltage Verification

QEW Level

QEW 2

Second Person Requirement

Not Required

Second Person Identified

n/a

Other Participants

n/a

Affected Persons Notified

N/A

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

29A15A1A

System Information Review

☑ Panel Schedules
☑

Control of Hazardous Energy

Simple LOTO

Equipment Condition

☑ Properly installed
☑ 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

LOTO circuit 29A15A1A-23, ZVV and replace wall power receptacle, remove LOTO and test power receptacle.

Control of Work Area

Minimum Approach Boundary

42 inches

Barricade Tape / Attendant

Danger - Red

Shock Risk Assessment

System Voltage

120 Vac

Limited Approach Boundary

42 inches

Restricted Approach Boundary

3 inches

Will the hands enter the RAB

No

Voltage Glove Class

00

Will any other part of the body enter the RAB

No

Arc Flash Risk Assessment

Incident Energy

4.23 cal/cm2

Arc Flash Boundary

40 inches

Working Distance

18 inches

Arc Flash PPE Level

Minimum PPE for Electrical Work

Incident Energy Reduction Measures

00

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

main corridor

Emergency Number to Call

911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

main corridor

Fire Extinguisher Location

main corridor

Contact Release Method Available and Tested

Voltage gloves

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

none

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
☑ Multimeter and other electrical test instruments

Notes / Other

none

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan