Time / Date: 3/4/2025 8:32:03
JSP ID: 3469
Scope of Work: Switching and LOTO Support Roof Exh Blowers AHU02
Work Order: W0425242
Building: 15
Person in Charge: Avery J Turner
Lead / Supervisor: Cameron, Benjamin
Logged Email: josephpica@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: Pica
List Other Participants: Cal Neva
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: Blower 03, 04, AHU2 sup and Return
System Information Review: Arc Flash Labels, System knowledge
Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
Equipment Condition: 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.

Notify Switch LOTO Mechanical ZVV

Control of Work Area

Minimum Approach Boundary: 65”
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: 277/480 V ac
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: 16cal cal/cm2
Arc Flash Boundary: 65”
Working Distance: 18 inches
Arc Flash PPE Level: 4
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: No Capacitor installed
Capacitor total stored energy (joules): No Capacitor installed
Discharge wait time (minutes): No Capacitor installed

Emergency Response Plan

Nearest Landline Location: 3rd Floor
Emergency Number to Call: 911
Sufficient cell phone signal?
Clear exit path? Yes
AED Location: Crew Carry
Fire Extinguisher Location: Roof Mount
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:

Brief Scope Communication

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

Notes / Other

LP-5583

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