Time / Date: 12/6/2022 7:22:06
JSP ID: 308
Scope of Work: Install data logger
Work Order: 304621
Building:
Person in Charge: Ben cameron
Lead / Supervisor: Cameron, Benjamin
Logged Email: AJTurner2@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Safety Watch
Second Person Identified: Avery Turner
List Other Participants: None
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: 27A21A
System Information Review: Panel Schedules
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Properly installed, 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.

Remove or open panel and install data logger to monitor circuit for 30 fays

Control of Work Area

Minimum Approach Boundary: 40
Barricade Tape / Attendant: Danger - Red

Shock Risk Assessment

System Voltage: 120/208 V ac
Limited Approach Boundary: 40 inches
Restricted Approach Boundary: 3 feet, 6 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 cal/cm2
Arc Flash Boundary: 40 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: Bling 78
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? No
AED Location: Blenheim 78
Fire Extinguisher Location: Blenheim 78
Contact release method available and tested: Rescue hook

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient/cramped/awkward space, Noisy environment

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

None

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