Scope of Work:Add 30 A two pole twist lock receptacle to existing circuits and jbox in ceiling.
General Information
Work Order
396425
Building
15
Person in Charge
Robert Ralph
Lead / Supervisor
Keusch, Justen
Logged Email
RobertRalph@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
Jared Tissot
Other Participants
Affected Persons Notified
Yes
System / Equipment
Switching
No Switching Required
Panel / Equipment ID
E362A1A
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑ Not energizing equipment for the first time ☑ or after electrical repair
Sequence of Job Steps
List basic sequence of steps from start to finish
1. Join LOTO 2. Perform ZVV on conductors at existing jbox. 3. Begin installing conduit 4. Pull conductors 5 install receptacle 6. Make up jbox and remove personal locks.
Control of Work Area
Minimum Approach Boundary
42”
Barricade Tape / Attendant
Attendant
Shock Risk Assessment
System Voltage
120/208 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
No
Arc Flash Risk Assessment
Incident Energy
9.84 cal cal/cm2
Arc Flash Boundary
58”
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
2
Incident Energy Reduction Measures
00
Capacitor Hazards
Capacitor Bus Voltage
Capacitor Total Stored Energy (Joules)
Discharge Wait Time (Minutes)
Emergency Response Plan
Nearest Landline Location
Inside this room
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
15 lobby
Fire Extinguisher Location
In this room
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) ☑ Rubber insulating gloves and leather protectors ☑ Multimeter and other electrical test instruments
Notes / Other
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)
