Time / Date: 8/5/2025 7:21:13
JSP ID: 4008
Scope of Work: Turn off breakers 28,33 in pnl-077-06
Work Order:
Building: Als
Person in Charge: Kevin hope
Lead / Supervisor: Combs, Everett
Logged Email: khope@lbl.gov
Division: ALS
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Safety Watch
Second Person Identified: Dave davis
List Other Participants:
Affected Persons Notified: N/A
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 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