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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 8/5/2025 7:21:13
JSP ID: 4008
Scope of Work: Turn off breakers 28,33 in pnl-077-06

General Information

Work Order
None
Building
Als
Person in Charge
Kevin hope
Lead / Supervisor
Combs, Everett
Logged Email
khope@lbl.gov
Division
ALS

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Safety Watch
Second Person Identified
Dave davis
Other Participants
Affected Persons Notified
N/A

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
310A
System Information Review
☑ Arc Flash Labels
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
Lotto circuit 28,33 in panel pnl-077-06, Zvv

Control of Work Area

Minimum Approach Boundary
75
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
No Shock Hazard Present
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
11.8 cal/cm2
Arc Flash Boundary
75”
Working Distance
24 inches
Arc Flash PPE Level
4
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
S0267
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Rack l123
Fire Extinguisher Location
Pnl 312 A
Contact Release Method Available and Tested

Environmental Conditions

Does the environment present additional hazards that should be addressed?
None

Error Precursors

Task Demands
Repetitive actions or monotony
Work Environment
Confusing displays or controls
Individual Capabilities
Unfamiliar with, or first time performing task
Human Nature
Complacency/overconfidence
Error Precursor Mitigations
Stay focused and present,Take time to read ask questions,Review task steps and procedures

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