Time / Date: 1/29/2025 9:21:27
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JSP ID: 3320
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Scope of Work: De-energizing panel to re route power for receptacles.
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Work Order:
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Building: 088
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Person in Charge: Erik Line
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Lead / Supervisor: Keusch, Justen
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Logged Email: eline@lbl.gov
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Division: Facilities
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QEW Level: QEW 2
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Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
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Second Person Requirement: Standby Person
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Second Person Identified: Patrick Coleman
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List Other Participants:
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Affected Persons Notified: Yes
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Switching: Hazardous Switching
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Panel / Equipment ID: 355A
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System Information Review: Arc Flash Labels
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Control of Hazardous Energy: Simple LOTO
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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
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Sequence of Job Steps
List basic sequence of steps from start to finish.
1. Switch breaker feeding panel 355A4A. 2. Establish LOTO 3. ZVV at receptacles. 4. Perform work. 5. Release LOTO. 6. Test new receptacles. |
Control of Work Area
Minimum Approach Boundary: 111
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Barricade Tape / Attendant: Attendant
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Shock Risk Assessment
System Voltage: 120/208 V ac
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Limited Approach Boundary: 42 inches
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Restricted Approach Boundary: 12 inches
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Will the hands enter the RAB: No
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Voltage Glove Class: 0
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Will any other part of the body enter the RAB: No
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Arc Flash Risk Assessment
Incident Energy: 22 cal/cm2
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Arc Flash Boundary: 111
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Working Distance: 18 inches
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Arc Flash PPE Level: 4
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Incident Energy Reduction Measures: 0
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Capacitor Hazards
Capacitor Bus Voltage:
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Capacitor total stored energy (joules):
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Discharge wait time (minutes):
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Emergency Response Plan
Nearest Landline Location: In room 161g
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Emergency Number to Call: 510-486-6999
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Sufficient cell phone signal? Yes
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Clear exit path? Yes
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AED Location: EM Shop
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Fire Extinguisher Location: Top of the west alley stairs.
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Contact release method available and tested: Voltage gloves
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Environmental Conditions
Does the environment present additional hazards that should be addressed?
Insufficient lighting, Using task light after panel is down. |
Error Precursors
Task Demands:
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Work Environment:
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Individual Capabilities:
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Human Nature:
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Error Precursor Mitigations:
N/A |
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
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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:
Rev 2023.08.22.1 Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov |