Time / Date: 11/30/2022 8:14:28
JSP ID: 280
Scope of Work: Apply Arc Flash Label To Disconnect Switch Disconnect Off Wearing proper PPE ZVV LOTO and Remove Seal Tight Load to Transformer Safe of Conductors in a Box. ZVV Transformer Remove Load From Transformer Completely Remove All Electrical Hazards From The Equipment. Leave Disconnect In the Open position with and Admin Lock
Work Order: 300975
Building:
Person in Charge: Christopher Nelson
Lead / Supervisor: Secheck, Stephen
Logged Email: cnelson@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: Alex Lopez
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 237A1A5A - Nano Writer Disconnect
System Information Review: Single Line Drawing, Arc Flash Labels
Control of Hazardous Energy: Simple LOTO
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.

Apply Arc Flash Label. Complete JSP Switch LOTO ZVV Remove Load From Disconnect. Open Transformer and ZVV line And Load. Isolate The Transformer From The Equipment. When It Is In An Electrically safe Condition Release LOTO and Apply a Blue Admin Lock

Control of Work Area

Minimum Approach Boundary: 42 Inches
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: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 5.83 cal/cm^2 cal/cm2
Arc Flash Boundary: 39 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:
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 1st floor lobby 100+ft away
Fire Extinguisher Location: Outside room 10ft
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient/cramped/awkward space

Error Precursors

Task Demands:
Work Environment: Distractions/interruptions, Unexpected equipment conditions
Individual Capabilities:
Human Nature: Stress (limits attention)
Error Precursor Mitigations:

Don’t be stressed keep the task at hand don’t get distracted be aware of any equipment changes while completing the task

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