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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 6/5/2025 12:35:43
JSP ID: 3802
Scope of Work: Troubleshoot ac unit 001

General Information

Work Order
442086
Building
6
Person in Charge
Antonio collado
Lead / Supervisor
Delgado, Alex
Logged Email
acollado@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
Darren kranz
Other Participants
Affected Persons Notified
N/A

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
304a7a3a / 06 ac 001
System Information Review
☑ Panel Schedules
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 zvv, checked unit , release of good .

Control of Work Area

Minimum Approach Boundary
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
Yes
Voltage Glove Class
0
Will any other part of the body enter the RAB
Yes

Arc Flash Risk Assessment

Incident Energy
0.18 cal/cm2
Arc Flash Boundary
5 inches
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
80-0118a left of entrance by window
Emergency Number to Call
6999
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Control room
Fire Extinguisher Location
Next to room 1193a
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Fall hazard

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