Time / Date: 3/5/2025 10:06:32
JSP ID: 3475
Scope of Work: Switch and LOTO and ZVV BA panel Rack B0107 for Data Workers to pull new network cable.
Work Order: 515062
Building: 6 ALS
Person in Charge: Christopher Nelson
Lead / Supervisor: Combs, Everett
Logged Email: cnelson@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: Alex lopez
List Other Participants: RI-William Fung and Mary Chan
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: 323A / BA B0107
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.

Meet with als EM and marry Chan briefing with ri fill out JSP pick proper PPE Switch LOTO and ZVV then remove my personal LOTO lock and hand over to ri

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: 11.9 cal/cm2
Arc Flash Boundary: 64 inches
Working Distance: 18 inches
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: In the booster pit area we are in on the rack.
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 15 lobby
Fire Extinguisher Location: In pi on wall within 20 feet of ZVV
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting

Error Precursors

Task Demands: Simultaneous or multiple tasks
Work Environment: Distractions/interruptions
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Keep in contact with others and use caution

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