Time / Date: 2/26/2025 10:31:07
JSP ID: 3443
Scope of Work: Electrically disconnect Beam Plug DC Motor (150 VDC, 2A)
Work Order:
Building: 88
Person in Charge: Scott Small
Lead / Supervisor: Other
Logged Email: smsmall@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Not Required
Second Person Identified:
List Other Participants:
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: B88 Cave 1 Beam Plug
System Information Review: Single Line Drawing
Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
Equipment Condition:

Sequence of Job Steps

List basic sequence of steps from start to finish.

LOTO/ZVV, Disconnect Motor, when work is complete then reconnect motor and clear LOTO.

Control of Work Area

Minimum Approach Boundary: 42
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120 VAC, 150 VDC
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 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: N/A cal/cm2
Arc Flash Boundary: N/A
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: 150 VDC
Capacitor total stored energy (joules): 11.25
Discharge wait time (minutes): 1

Emergency Response Plan

Nearest Landline Location: Cave 1 desk
Emergency Number to Call: 7911
Sufficient cell phone signal? No
Clear exit path? No
AED Location: Portable brought to work site
Fire Extinguisher Location: Cave wall
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:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

None identified

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
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 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