QEW 1 / 2 / 3 Job Safety Plan

Time / Date: 6/4/2025 8:07:43

JSP ID: 3792

Scope of Work: Turn off circuits, ZVV, terminate liquid tite at outlet box and connect conductors to receptacles and drill press

General Information

Work Order

426107

Building

Person in Charge

Robert Ralph

Lead / Supervisor

Combs, Everett

Logged Email

RobertRalph@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 0 - Electrically Safe Work Condition
☑ 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

Hazardous Switching

Panel / Equipment ID

342A1A19A

System Information Review

☑ Panel Schedules

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.)Open CB #19 2.)ZVV at jbox with circuit 19&27 3.) Establish LOTO @CB#19 & 27 4.)terminate liquid tite and conductors at drill press. 5.) notify affected parties 6.) release LOTO 7.) Re energize CB #19 & #27

Control of Work Area

Minimum Approach Boundary

72”

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

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

11 cal/cm2

Arc Flash Boundary

72”

Working Distance

18 inches

Arc Flash PPE Level

Incident Energy Reduction Measures

Capacitor Hazards

Capacitor Bus Voltage

Capacitor Total Stored Energy (Joules)

Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location

Machine shop office

Emergency Number to Call

911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

Lobby B6

Fire Extinguisher Location

Outside machine shop office

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

Went over everything and everything is good.

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan