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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 1/17/2025 8:04:57
JSP ID: 3282
Scope of Work: LOTO 76-KC-07

General Information

Work Order
W0416370
Building
B76
Person in Charge
Colmenares
Lead / Supervisor
Cameron, Benjamin
Logged Email
josephpica@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Pica
Other Participants
PMTs
Affected Persons Notified
Yes

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
MCC Mounted Disconnect 76KC07
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
☑ Hand over Hand trace
Control of Hazardous Energy
Simple LOTO
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
Identify Notify Switch Verify Confirm Restore

Control of Work Area

Minimum Approach Boundary
42
Barricade Tape / Attendant
Attendant

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
15.1cal/cm2 cal/cm2
Arc Flash Boundary
88”
Working Distance
18 inches
Arc Flash PPE Level
4
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
No Capacitor
Capacitor Total Stored Energy (Joules)
No Capacitor
Discharge Wait Time (Minutes)
No Capacitor

Emergency Response Plan

Nearest Landline Location
Wall Mount
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Crew Carry
Fire Extinguisher Location
Wall Mount
Contact Release Method Available and Tested
Upstream breaker or switch

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)
☑ 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

Notes / Other

None

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:
  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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov