Time / Date: 11/29/2022 19:45:01
JSP ID: 278
Scope of Work: LOTO AHU 11 VFD to wire in door interlocks
Work Order: NA
Building:
Person in Charge: Ernie Jew
Lead / Supervisor: Grounds, Jeff
Logged Email: ejew@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: AJ Palengat
List Other Participants: NA
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: E590A7A - 3
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Complex LOTO w/ RI
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.

Notify the Control room. Turn off AHU 11 in the BMS. Turn VFD off at VFD display. Open VFD disconnect. Open Breaker 3 at E590A7A. Apply LOTO. ZVV at AHU 1 VFD. Perform work. Notify the Control room. Release LOTO. Close breaker 3 at E590A7A. Close VFD disconnect. Put VFD in Auto at VFD display. Put VFD in Auto at BMS.

Control of Work Area

Minimum Approach Boundary: 42"
Barricade Tape / Attendant: Warning - Orange

Shock Risk Assessment

System Voltage: 277/480 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: Yes
Voltage Glove Class: 00
Will any other part of the body enter the RAB: Yes

Arc Flash Risk Assessment

Incident Energy: 1.31 cal/cm2
Arc Flash Boundary: 19"
Working Distance: 18 inches
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 00

Capacitor Hazards

Capacitor Bus Voltage: NA
Capacitor total stored energy (joules): NA
Discharge wait time (minutes): NA

Emergency Response Plan

Nearest Landline Location: Container office
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 3rd floor next to Mens room
Fire Extinguisher Location: Inside UPS room
Contact release method available and tested: Upstream breaker or switch, Rescue hook, 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:

NA

PPE Inspections

Notes / Other

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