Time / Date: 5/15/2025 12:27:05
JSP ID: 3742
Scope of Work: Loto, ZVV, investigate existing branch circuit wiring and install new raceways and jboxes for cubicle rearrangement. Pull in new conductors, inspect.
Work Order: 404719
Building: 69
Person in Charge: Shane Miller
Lead / Supervisor: Secheck, Stephen
Logged Email: spmiller@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: Alex Lopez
List Other Participants: Steve Sechak
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: 217A1A3A
System Information Review: Panel Schedules, Arc Flash Labels
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.

1. Dawn the proper PPE 2. Apply Loto at panel 217A1A3A ckt 4 3. Hang red locks 4. ZVV at panel 233A 5. Investigate existing branch circuits 6. Install new raceways/jboxes 7. Pull in new branch circuit wiring 8. Add new breakers to panel 233A and tie in new branch circuit wires. 9. Inspect rough in and megger wire 10. Leave all new wiring in electrical safe condition. Hang blue admin. Locks on newly installed breakers. 11. Release LOTO at panel 217A1A3A 12. Clean up and wait for new cubicles to be installed.

Control of Work Area

Minimum Approach Boundary: 42”
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: 277/480 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: 4.09cal/cm2 cal/cm2
Arc Flash Boundary: 35”
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: Using cell phone with good signal
Emergency Number to Call: X6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: In Vehicle outside building, 100’ away
Fire Extinguisher Location: In break room 35’ away
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

None

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