QEW 1 / 2 / 3 Job Safety Plan

Time / Date: 4/9/2025 10:20:09

JSP ID: 3600

Scope of Work: Investigate feeder wire size and power disconnect fuse size feeding dishwasher in room 0236 at building 33

General Information

Work Order

429762

Building

033

Person in Charge

Alejandro Lopez

Lead / Supervisor

Ramer, Robert

Logged Email

Alopez2@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

ARMAND URIBE

Other Participants

NONE

Affected Persons Notified

N/A

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

634A1A3A

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

Sequence of Job Steps

List basic sequence of steps from start to finish

Apply simple LOTO, ZVV and take a look inside power disconnect to determine wire size and fuse size

Control of Work Area

Minimum Approach Boundary

Barricade Tape / Attendant

Attendant

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

Voltage Glove Class

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

0.42 cal/cm2

Arc Flash Boundary

10 INCHES

Working Distance

18 inches

Arc Flash PPE Level

Minimum PPE for Electrical Work

Incident Energy Reduction Measures

Capacitor Hazards

Capacitor Bus Voltage

N/A

Capacitor Total Stored Energy (Joules)

N/A

Discharge Wait Time (Minutes)

N/A

Emergency Response Plan

Nearest Landline Location

cell phone

Emergency Number to Call

911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

in vehicle

Fire Extinguisher Location

in vehicle

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

NONE

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

NONE

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan