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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 2/10/2025 7:46:03
JSP ID: 3357
Scope of Work: Pm for 56A-AC-003

General Information

Work Order
419664
Building
56A
Person in Charge
Gerald Fowler
Lead / Supervisor
Delgado, Alex
Logged Email
gdfowler@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
Mike Capeto
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
631A4A/56A-AC-003
System Information Review
☑ 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
Loto out unit then perform the pm

Control of Work Area

Minimum Approach Boundary
42 inches
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
Yes
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
18 inches
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
Office 111
Emergency Number to Call
510-486-6999/7911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Inside front door
Fire Extinguisher Location
Office 111
Contact Release Method Available and Tested
Upstream breaker or switch, Rescue hook, Voltage gloves

Environmental Conditions

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

Error Precursors

Task Demands
Time pressure (in a hurry), High workload (memory requirements), Simultaneous or multiple tasks, Repetitive actions or monotony, Critical steps or irreversible acts, Interpretation requirements, Unclear goals, roles, or responsibilities, Lack of or unclear standards
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
☑ 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