Time / Date: 12/16/2024 9:27:51
JSP ID: 3199
Scope of Work: Open circuit Breaker 317 @ 302A3A and perform ZVV in order to replace 6x6” T with a straight piece of 6x6” wire way.
Work Order: 412504
Building: 6
Person in Charge: Robert Ralph
Lead / Supervisor: Combs, Everett
Logged Email: RobertRalph@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: Chris Nelson
List Other Participants: EM shop
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 302A3A
System Information Review: 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.

1.) Open CB# 317 @ 302A3A 2.) perform ZVV @ Wireway 3.) Remove T 4.) Replace T with Straight piece. 5.) let someone know we are ready to reenergize. 6. Release LOTO and reenergize.

Control of Work Area

Minimum Approach Boundary: 60”
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: 8.14 cal/cm2
Arc Flash Boundary: 60”
Working Distance: 18 inches
Arc Flash PPE Level: 3
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: S0267 Ishtar next to this rack in the storage ring pit
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Lobby B6
Fire Extinguisher Location: Right outside RF area in the storage ring pot
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Heavy traffic, Noisy environment

Error Precursors

Task Demands: Time pressure (in a hurry), Simultaneous or multiple tasks
Work Environment:
Individual Capabilities:
Human Nature: Complacency/overconfidence
Error Precursor Mitigations:

Go over, pre cursors so they can be addressed and mitigated.

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,
Insulated tools,
Multimeter and other electrical test instruments

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