Time / Date: 1/13/2025 9:10:52
JSP ID: 3262
Scope of Work: Switch panel 306A4A and Hang Red LOTO Locks for safety
Work Order: 412148
Building: 6ALS
Person in Charge: Christopher Nelson
Lead / Supervisor: Combs, Everett
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: Mayumi Taylor
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 306A4A
System Information Review: Panel Schedules, 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.

Switch

Control of Work Area

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

Arc Flash Risk Assessment

Incident Energy: 4.52 cal/cm2
Arc Flash Boundary: 37
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: Inside the BSISB lab
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: In lobby of 6 ALS
Fire Extinguisher Location: On the outside of the BSISB LAB
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: Repetitive actions or monotony
Work Environment: Confusing displays or controls
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Be aware of precursors

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

Switching equipment to work on the outside of the equipment will not be inside the gear ZVV on outside test port

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