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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 4/7/2025 8:19:44
JSP ID: 3584
Scope of Work: LOTO circuits to be relocated

General Information

Work Order
415067
Building
80 011A
Person in Charge
Christopher Nelson
Lead / Supervisor
Combs, Everett
Logged Email
cnelsom@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
David Davis
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
579A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
☑ ALS complex LOTO form
Control of Hazardous Energy
Complex LOTO (requires LP, CLP, FLP)
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 jha JSP als complex LOTO form switch LOTO ZVV and then do work when work is completed release the LOTO and switch back on circuits

Control of Work Area

Minimum Approach Boundary
Barricade Tape / Attendant
Warning - Orange

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
3 feet, 6 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
5.03 cal/cm2
Arc Flash Boundary
40
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
Down the hall near fire extinguishers
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
In b 15
Fire Extinguisher Location
Down the hall by room 012
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
Distractions/interruptions
Individual Capabilities
Human Nature
Habit patterns
Error Precursor Mitigations
Be aware and alert to any situation

PPE Inspections

☑ Safety glasses (ANSI Z87)
☑ Arc-rated clothing (flash suit
☑ daily wear) including face shield
☑ balaclava
☑ hood.
☑ Hearing protection
☑ Non-melting footwear that fully covers the feet
☑ Removal of conductive articles
☑ Insulated tools
☑ Multimeter and other electrical test instruments

Notes / Other

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