Time / Date: 3/4/2025 12:34:08
JSP ID: 3470
Scope of Work: Complete Lotto LP 3248
Work Order: Training
Building: 75a
Person in Charge: Mike Rose
Lead / Supervisor: Cameron, Benjamin
Logged Email: avery.turner98@gmail.com
Division: Facilities
QEW Level: QEW 3
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Safety Watch
Second Person Identified: Joe Pica
List Other Participants: None
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: Bus 101
System Information Review: Arc Flash Labels
Control of Hazardous Energy: Complex LOTO w/ RI
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.

Perform PPE inspection and equipment inspection then ZVV bus 101 so we can install ground clusters in order to bring Bus 101 to a safe working condition so we can test the cables an make up and terminate

Control of Work Area

Minimum Approach Boundary: 27.2
Barricade Tape / Attendant: Danger - Red

Shock Risk Assessment

System Voltage: 12,470 V ac
Limited Approach Boundary: 60 inches
Restricted Approach Boundary: 2 feet, 2 inches
Will the hands enter the RAB: No
Voltage Glove Class: 2
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 28.1 cal/cm2 cal/cm2
Arc Flash Boundary: 233
Working Distance: 36 inches
Arc Flash PPE Level: 4
Incident Energy Reduction Measures: 2

Capacitor Hazards

Capacitor Bus Voltage: None
Capacitor total stored energy (joules): None
Discharge wait time (minutes): None

Emergency Response Plan

Nearest Landline Location: Not working
Emergency Number to Call: 6911/911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Onsite
Fire Extinguisher Location: Outside of the door
Contact release method available and tested: Rescue hook, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities: Unfamiliar with, or first time performing task
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

Notes / Other

Wiped down shot gun

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