QEW 1 / 2 / 3 Job Safety Plan

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Time / Date: 4/10/2025 9:55:25

JSP ID: 3611

Scope of Work: Reset tripped main breaker in electrical panel 245A5A28A on 2nd floor building 2

General Information

Work Order

431120

Building

002

Person in Charge

Alejandro Lopez

Lead / Supervisor

Ramer, Robert

Logged Email

Alopez2@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 0 - Electrically Safe Work Condition

QEW Level

QEW 2

Second Person Requirement

Not Required

Second Person Identified

N/A

Other Participants

NONE

Affected Persons Notified

Yes

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

245A5A28A

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

Wear proper PPE and reset circuit breaker

Control of Work Area

Minimum Approach Boundary

3 inches

Barricade Tape / Attendant

Warning - Orange

Shock Risk Assessment

System Voltage

120/208 V ac

Limited Approach Boundary

42 inches

Restricted Approach Boundary

3 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

14.1 Cals cal/cm2

Arc Flash Boundary

70 Inches

Working Distance

18 inches

Arc Flash PPE Level

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

inside room 256

Emergency Number to Call

911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

on second floor main corridor

Fire Extinguisher Location

on second floor main corridor

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