Time / Date: 3/3/2025 11:30:01
JSP ID: 3465
Scope of Work: Turn off breaker in PNL318A circuit 38
Work Order: W0415062
Building: ALS Building 6
Person in Charge: Mayumi Taylor
Lead / Supervisor: Keusch, Justen
Logged Email: mjtaylor@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Dave Davis
List Other Participants: n/a
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 318A
System Information Review: Panel Schedules, 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.

Verify panel and circuit, turn off breaker, LOTO and ZVV

Control of Work Area

Minimum Approach Boundary: 42"
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120/208 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 18"
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: 16.9 cal/cm2 cal/cm2
Arc Flash Boundary: 94in
Working Distance: 42"
Arc Flash PPE Level: 2
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: Booster Pit
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Building 6 lobby
Fire Extinguisher Location: Building 6 lobby
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting, Confined space, Insufficient/cramped/awkward space, Lookalike equipment

Error Precursors

Task Demands:
Work Environment: Distractions/interruptions, Obscure electrical supplies or configurations
Individual Capabilities: Unfamiliar with, or first time performing task
Human Nature: Assumptions, Complacency/overconfidence
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

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