QEW 1 / 2 / 3 Job Safety Plan

General Information

Work Order

439089

Building

71

Person in Charge

Shane Miller

Lead / Supervisor

Ramer, Robert

Logged Email

spmiller@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 1 - LOTO & Zero Voltage Verification

QEW Level

QEW 2

Second Person Requirement

Not Required

Second Person Identified

Other Participants

Affected Persons Notified

N/A

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

EM22A-13

System Information Review

☑ Panel Schedules

Control of Hazardous Energy

Simple LOTO

Equipment Condition

☑ Properly installed
☑ 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

Loto, ZVV, replace 20a receptacle

Control of Work Area

Minimum Approach Boundary

Barricade Tape / Attendant

Shock Risk Assessment

System Voltage

No Shock Hazard Present

Limited Approach Boundary

42 inches

Restricted Approach Boundary

3 inches

Will the hands enter the RAB

No

Voltage Glove Class

00

Will any other part of the body enter the RAB

No

Arc Flash Risk Assessment

Incident Energy

<1.2 cal/cm2

Arc Flash Boundary

18

Working Distance

No Arc Flash Hazard Present

Arc Flash PPE Level

Minimum PPE for Electrical Work

Incident Energy Reduction Measures

00

Capacitor Hazards

Capacitor Bus Voltage

Capacitor Total Stored Energy (Joules)

Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location

Corridor 71

Emergency Number to Call

X6999

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

71 corridor

Fire Extinguisher Location

71 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
☑ 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:

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