Logo

QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
Back to Index
Time / Date: 1/31/2025 7:39:41
JSP ID: 3323
Scope of Work: Diagnose failure on boiler

General Information

Work Order
422303
Building
90
Person in Charge
Capeto
Lead / Supervisor
Delgado, Alex
Logged Email
mcapeto@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Geraldo
Other Participants
None
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
99A6A/ 90 BR 005
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑

Sequence of Job Steps

List basic sequence of steps from start to finish
Electrical and mechanical troubleshooting

Control of Work Area

Minimum Approach Boundary
NA
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
None
Restricted Approach Boundary
None
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
NA cal/cm2
Arc Flash Boundary
NA
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
NA
Capacitor Total Stored Energy (Joules)
NA
Discharge Wait Time (Minutes)
NA

Emergency Response Plan

Nearest Landline Location
Hallway near exit
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Lobby
Fire Extinguisher Location
Hallway near exit
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Lookalike equipment, Noisy environment

Error Precursors

Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
Reviewed

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 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