Time / Date: 12/19/2022 9:03:34
JSP ID: 369
Scope of Work: Perform annual on 64 Aru 004
Work Order: 299264
Building:
Person in Charge: Juan Garcia
Lead / Supervisor: Delgado, Alex
Logged Email: jwwalker@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Justin walker
List Other Participants: None
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: MCC5181A / 64 ARU 004
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.

Go over briefing and scope of work. Inspect ppe. And tools, set up barricade tape. Standby person also on site. Put on ppe, switch disconnect located by 64 Aru 004 Apply loto, verify ZVV. Inspect electrical and tighten connections. Take oil sample on compressors. Clean condensor coils. Perform leak check on refrigerant piping. Look for any signs of oil. Inspect fan blades and motors. Wipe down chiller. Remove loto. And verify operations. Clean up area. Submit work log.

Control of Work Area

Minimum Approach Boundary: 42
Barricade Tape / Attendant: Warning - Orange

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: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 6.40 cal/cm^2 cal/cm2
Arc Flash Boundary: 41 inches
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 00

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: Building 64 room 115
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Outside room 142 building 64
Fire Extinguisher Location: Inside back door outside room 64/ 102
Contact release method available and tested: Upstream breaker or switch, Rescue hook, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

There are areas with uneven surfaces to be mindful of. Also water piping.

Error Precursors

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

There are no error precursors first job out the day no pressure or time restraints. Technicians are rested and alert. And are comfortable with job and scope of work

PPE Inspections

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