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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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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

General Information

Work Order
435936
Building
80
Person in Charge
Christopher Nelson
Lead / Supervisor
Combs, Everett
Logged Email
cnelson@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Mayumi Taylor
Other Participants
Affected Persons Notified
Yes

System / Equipment

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 Briefing

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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov