Time / Date: 3/18/2025 10:50:12
JSP ID: 3513
Scope of Work: Switch Tripped. Breaker
Work Order: 415067
Building: ALS 6
Person in Charge: Mayumi Taylor
Lead / Supervisor: Combs, Everett
Logged Email: cnelson@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Standby Person
Second Person Identified: Christopher Nelson
List Other Participants:
Affected Persons Notified: Yes
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 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