Time / Date: 4/4/2025 8:45:08
JSP ID: 3580
Scope of Work: Install data logger on panel E80A3A17A28A1A for a 1 week load study.
Work Order:
Building: 88
Person in Charge: Erik line
Lead / Supervisor: Keusch, Justen
Logged Email: eline@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Safety Watch
Second Person Identified: Justen K
List Other Participants:
Affected Persons Notified: N/A
Switching: No Switching Required
Panel / Equipment ID: E80A3A17A28A1A
System Information Review: 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.

1. Open door to panel. 2. Install attachment around each phase conductor on the line side. 3. Close door

Control of Work Area

Minimum Approach Boundary: 42in
Barricade Tape / Attendant: Danger - Red

Shock Risk Assessment

System Voltage: 277/480 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: 5.43 cal/cm2
Arc Flash Boundary: 42in
Working Distance: 18 inches
Arc Flash PPE Level: 2+
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage:
Capacitor total stored energy (joules):
Discharge wait time (minutes):

Emergency Response Plan

Nearest Landline Location: Office 015
Emergency Number to Call: 510-486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: EM shop
Fire Extinguisher Location: At west entry door adjacent the the work location.
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:

N/A

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,
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