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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 3/18/2025 10:50:12
JSP ID: 3513
Scope of Work: Switch Tripped. Breaker

General Information

Work Order
415067
Building
ALS 6
Person in Charge
Mayumi Taylor
Lead / Supervisor
Combs, Everett
Logged Email
cnelson@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Christopher Nelson
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
319A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
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
Fill out JSP contact the people involved with this issue and notify them we are switching. Barricade off area and signage of arc flash boundary. Switch when everything is ready and we have on our PPE. Make sure breaker is reset.

Control of Work Area

Minimum Approach Boundary
42
Barricade Tape / Attendant
Warning - Orange

Shock Risk Assessment

System Voltage
No Shock Hazard Present
Limited Approach Boundary
Na
Restricted Approach Boundary
Na
Will the hands enter the RAB
No
Voltage Glove Class
0
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
22.5 cal/cm2
Arc Flash Boundary
113 inches
Working Distance
18 inches
Arc Flash PPE Level
1
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
Na
Capacitor Total Stored Energy (Joules)
Na
Discharge Wait Time (Minutes)
Na

Emergency Response Plan

Nearest Landline Location
At sector 6 labyrinth door
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Lobby of als 6
Fire Extinguisher Location
Next to land line
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Insufficient/cramped/awkward space, Scaffolding is close by

Error Precursors

Task Demands
Work Environment
Distractions/interruptions
Individual Capabilities
Human Nature
Mind-set
Error Precursor Mitigations
Keep your cool don’t rush

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

Just switching

Perform Job Briefing

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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov