QEW 1 / 2 / 3 Job Safety Plan

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Time / Date: 6/5/2025 12:42:00

JSP ID: 3803

Scope of Work: Remove jbox with 2 receptacles, demo conductors to closest box, replace single receptacle with two

General Information

Work Order

415067

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

Non-Hazardous Switching

Panel / Equipment ID

342A1A19A51A

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

1.)Turn off Circuit #19 2.)establish LOTO @CB#19 panel 342A1A19A51A 3.) ZVV @ jbox to be demoed 4.)remove conductors, conduit and jbox 5.) turn circuit on when work is complete..

Control of Work Area

Minimum Approach Boundary

66”

Barricade Tape / Attendant

Attendant

Shock Risk Assessment

System Voltage

120 Vac

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

9.68 cal/cm2

Arc Flash Boundary

66”

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

Mashing 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

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