Time / Date: 4/18/2025 10:50:08
JSP ID: 3647
Scope of Work: Disconnect wiring between heater ring and Heater control boxes. Unmount boxes and return them to LBL
Work Order:
Building: Pt Reyes Field Site
Person in Charge: Todd Wood
Lead / Supervisor: Other
Logged Email: TJWood@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Not Required
Second Person Identified:
List Other Participants:
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: PP1-8
System Information Review:
Control of Hazardous Energy: Cord & Plug LOTO
Equipment Condition:

Sequence of Job Steps

List basic sequence of steps from start to finish.

1. Establish Loto - Unplug 240 VAC plug, place a cord cap lock and tag. 2. Open enclosure - preform ZVV 3. ensure all breakers in the panel are OFF 4. disconnect phases and ground for the 2 heater circuits. 5. disconnect the low voltage signals from the datalogger 6. apply tape to protect all exposed wire ends 7. remove enclosures from the plywood backpanel

Control of Work Area

Minimum Approach Boundary: 42
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120/240 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: NA cal/cm2
Arc Flash Boundary: NA
Working Distance: No Arc Flash Hazard Present
Arc Flash PPE Level: Minimum PPE for Electrical Work
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: Pt Reyes House
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location:
Fire Extinguisher Location: Barn
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location, Lookalike equipment

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Consult task list, verbalize steps

PPE Inspections

Safety glasses (ANSI Z87),
Rubber insulating gloves and leather protectors,
Non-melting footwear that fully covers the feet,
Removal of conductive articles,
Insulated tools,
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