Time / Date: 5/9/2025 7:58:02
JSP ID: 3716
Scope of Work: ZVV Panel we Switched and LOTO to Remove A circuit in the room of this panel demo of circuit 5 receptacle
Work Order: 435936
Building: 80
Person in Charge: Christopher Nelson
Lead / Supervisor: Combs, Everett
Logged Email: cnelson@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: Mayumi Taylor
List Other Participants:
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: 342A1A7A4A
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, 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 is established fill out ZVV JSP test meter wear proper PPE create a barricade remove panel cover and check for absence of voltage

Control of Work Area

Minimum Approach Boundary: 54
Barricade Tape / Attendant: Warning - Orange

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: 6.96 cal/cm2
Arc Flash Boundary: 54”
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: Na
Capacitor total stored energy (joules): Naa
Discharge wait time (minutes): Naaa

Emergency Response Plan

Nearest Landline Location: In room 50’ from panel
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: B 80 control room
Fire Extinguisher Location: Just outside room 038
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: Simultaneous or multiple tasks, Repetitive actions or monotony
Work Environment: Distractions/interruptions
Individual Capabilities:
Human Nature: Mind-set
Error Precursor Mitigations:

Have a good attitude and be aware of changes that may occur

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

ZVV JSP

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