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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 5/15/2025 9:08:34
JSP ID: 3739
Scope of Work: Install Data Logger in Panel

General Information

Work Order
W0439713
Building
74
Person in Charge
Alma Armenta
Lead / Supervisor
Cameron, Benjamin
Logged Email
alarmentaduran@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Safety Watch
Second Person Identified
Joe Colmenares
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
47A3A34A40A
System Information Review
☑ Arc Flash Labels
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
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
Set up work area with barricade tape, inspect panel, access panel, install data logger, verify operation, close panel, inspect work area for safety.

Control of Work Area

Minimum Approach Boundary
54”
Barricade Tape / Attendant
Danger - Red

Shock Risk Assessment

System Voltage
120/208 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
8.74 cal/cm2
Arc Flash Boundary
54”
Working Distance
18 inches
Arc Flash PPE Level
4
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
None
Capacitor Total Stored Energy (Joules)
None
Discharge Wait Time (Minutes)
None

Emergency Response Plan

Nearest Landline Location
In room 306
Emergency Number to Call
510-486-7911 (911 from Lab Phone)
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
At main door
Fire Extinguisher Location
Next to panel
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Lookalike equipment

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:
  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