QEW 1 / 2 / 3 Job Safety Plan
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Time / Date:
12/20/2024 8:40:45
JSP ID:
3221
Scope of Work:
Remove and replace juice box with xeal.
General Information
Work Order
413181
Building
76
Person in Charge
Nick g
Lead / Supervisor
Secheck, Stephen
Logged Email
ngripe@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Beau erwin
Other Participants
Affected Persons Notified
N/A
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
501A7A/17
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑ Properly installed
☑ All doors and covers closed and fully latched
☑ No signs of impending failure
Sequence of Job Steps
List basic sequence of steps from start to finish
Loto. Zvv. R and R. Release loto. Re energize
Control of Work Area
Minimum Approach Boundary
60in
Barricade Tape / Attendant
Warning - Orange
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
No
Voltage Glove Class
0
Will any other part of the body enter the RAB
No
Arc Flash Risk Assessment
Incident Energy
8.03 cal/cm2
Arc Flash Boundary
51
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
Minimum PPE for Electrical Work
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
Inside 76
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
76 hall
Fire Extinguisher Location
By door
Contact Release Method Available and Tested
Voltage gloves
Environmental Conditions
Does the environment present additional hazards that should be addressed?
Heavy traffic
Error Precursors
Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
Na
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
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)
Emergency Response Plan
