Time / Date: 5/14/2025 9:44:19
JSP ID: 3733
Scope of Work: LOTO the 1400 Helium Refrigerator and inspect/repair.
Work Order: N/A
Building: 88
Person in Charge: Brendan Ford
Lead / Supervisor: Other
Logged Email: bpford@lbl.gov
Division: Other
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Yes
List Other Participants: Building 88 Control Room and Mechanical shop and outside vendor (Negative One Eighty).
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: Station A 1400 Helium Refrigerator
System Information Review: Single Line Drawing, Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Complex LOTO w/ RI
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.

1. Inform Control Room and Mechanical group to have the unit safely shut down. 2. Perform the LOTO using LOTO procedure R2A-5. 3. Perform Inspection/repairs. 4.Verify with Control Room and Mechanical group that unit is safe/ready to remove LOTO R2A-5. 5. Remove LOTO and return control back to Control Room and Mechanical Group.

Control of Work Area

Minimum Approach Boundary: 42 inches
Barricade Tape / Attendant: Notice - Blue

Shock Risk Assessment

System Voltage: 120 V ac, 240 V ac, 480 V ac.
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: No
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 480 V ac is 5.64. 240 V ac is 9.69. cal/cm2
Arc Flash Boundary: 67 inches.
Working Distance: 18 inches
Arc Flash PPE Level: 2+
Incident Energy Reduction Measures: 0

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: 15 feet away directly to the West on wall.
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Brought to switching location.
Fire Extinguisher Location: 4 feet away directly behing wall of panels being switched..
Contact release method available and tested: Rescue hook, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Noisy environment

Error Precursors

Task Demands: Critical steps or irreversible acts
Work Environment: Distractions/interruptions
Individual Capabilities:
Human Nature: Stress (limits attention)
Error Precursor Mitigations:

Have standby person double check each step verbally as it is performed per the LOTO procedure.

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 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